ATT001_Glossary Survivor CCE Recompete.xlsx
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- Attached to
- Solicitation - World Trade Center Health Program - Survivor Clinical Center of Excellence
- Solicitation number
- CDC-75D301-01-Solicitation-WTCHP
About this file
This file is a comprehensive glossary for the World Trade Center Health Program Survivor Clinical Center of Excellence (CCE) contract, providing detailed definitions and acronyms related to the program's healthcare services for 9/11 survivors and responders. The glossary covers key terms associated with medical monitoring, treatment, and administrative functions for individuals impacted by the September 11, 2001 terrorist attacks, including definitions for different responder categories, health conditions, and program-specific roles and contractors.
The document defines critical terms such as "Survivors" (persons present in the NYC Disaster Area during or after 9/11), "WTC-related health conditions" (illnesses potentially caused by exposure to airborne toxins), and various program components like Clinical Centers of Excellence (NYMA-based medical facilities providing comprehensive healthcare services). It outlines the program's scope, which includes medical monitoring, diagnosis, certification, treatment services, case management, and benefits counseling for eligible responders and survivors in the New York Metropolitan Area, with specific focus on healthcare delivery, administrative processes, and supporting contractor roles like the Nationwide Provider Network Administrator, Health Program Support/Third-Party Administrator, and Pharmacy Benefits Manager.
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Sheet1
| Section | Term | Acronym or Shorthand | Definition |
| 1 | Centers for Disease Control and Prevention | CDC | |
| 1 | Clinical Center of Excellence | CCE | |
| 1 | Health Program Support/Third-Party Administrator | HPS/TPA | |
| 1 | James Zadroga 9/11 Health and Compensation Act of 2010 | Zadroga Act | |
| 1 | National Institute for Occupational Safety and Health | NIOSH | |
| 1 | Nationwide Provider Network | NPN | |
| 1 | New York Metropolitan Area | NYMA | |
| 1 | New York City | NYC | |
| 1 | Pharmacy Benefits Manager | PBM | |
| 1 | World Trade Center Health Program | Program | The program established by Title XXXIII of the Public Health Service Act, as amended, 42 U.S.C. 300mm to 300mm-61 (codifying Title I of the James Zadroga 9/11 Health and Compensation Act of 2010 , Pub. L. 111-347, as amended by Pub. L. 114-113 and Pub. L. 116-59), to provide medical monitoring and treatment benefits for eligible responders to the September 11, 2001, terrorist attacks and initial health evaluation, monitoring, and treatment benefits for residents and other building occupants and area workers in New York City who were directly impacted and adversely affected by such attacks. See 42 CFR 88.1. |
| 1.1 | Coordination of Benefits | COB | |
| 1.1 | Pentagon and Shanksville, PA Responders | Fire or police department employees (fire or emergency personnel, active or retired), Department of Defense or other Federal agency employees and contractors, members of the regular or reserve uniformed services, recovery, or cleanup contractor workers, or volunteers, who performed rescue, recovery, demolition, debris cleanup, or other related services after the terrorist-related aircraft crashes on September 11, 2001, at the Pentagon in Arlington, VA, or in Shanksville, PA. As of March 2024, there are 1,161 Pentagon Responder and 143 Shanksville Responder members. | |
| 1.1 | Responders | Workers or volunteers who provided rescue, recovery, debris cleanup, and related support services on or in the aftermath of the September 11, 2001, terrorist attacks at the World Trade Center, the Pentagon, or the aircraft crash site near Shanksville, PA | |
| 1.1 | Survivors | Persons who were present in the New York City (NYC) Disaster Area in the dust or dust cloud on September 11, 2001, or who worked, resided, or attended school, childcare, or adult daycare in the NYC Disaster Area for a certain period following the September 11, 2001, terrorist attacks. | |
| 1.1 | WTC Responder – affiliated with the Fire Department of the City of New York (FDNY) | FDNY Responder | An individual (active or retired) who participated at least one day in the rescue and recovery effort at any of the former World Trade Center sites (including Ground Zero, Staten Island Landfill, and the New York City Chief Medical Examiner’s Office). As of March 2024, there are 17,059 FDNY Responder members. |
| 1.1 | WTC Responder – Fire Department of the City of New York (FDNY) Family Member | FDNY Family | A surviving immediate family member of an FDNY member (whether fire or emergency personnel, active or retired) who was killed at the World Trade Center site on September 11, 2001, and received any treatment for a WTC-related mental health condition on or before September 1, 2008. As of March 2024, there are 667 FDNY Family members. |
| 1.1 | WTC Responder – not affiliated with Fire Department of the City of New York | Non-FDNY Responder or General Responder | An individual who worked or volunteered onsite in rescue, recovery, demolition, debris cleanup, or related support services in lower Manhattan (south of Canal St.), the Staten Island Landfill, or the barge-loading piers; a member of the Police Department of New York City (active or retired) or a member of the Port Authority Police of the Port Authority of New York and New Jersey (active or retired) who participated onsite in rescue, recovery, debris cleanup, or related services in lower Manhattan (south of Canal St.), including Ground Zero, the Staten Island Landfill, or the barge loading piers; an employee of the Office of the Chief Medical Examiner of New York City involved in the examination and handling of human remains from the World Trade Center attacks, or other morgue worker who performed similar post-September 11 functions for such Office staff; a worker in the Port Authority Trans-Hudson Corporation Tunnel; or a vehicle-maintenance worker who was exposed to debris from the former World Trade Center while retrieving, driving, cleaning, repairing, and maintaining vehicles contaminated by airborne toxins from the September 11, 2001, terrorist attacks. As of March 2024, there are 70,955 General Responder members. |
| 1.1 | WTC Survivor | An individual present in the New York City Disaster Area in the dust or dust cloud on September 11, 2001; an individual who lived, worked, or went to school, childcare, or adult daycare in lower Manhattan south of Houston Street and certain parts of Brooklyn; certain cleanup and maintenance workers in the New York City Disaster Area; and certain residents and individuals whose place of employment were deemed eligible to receive certain grants from the Lower Manhattan Development Corporation. | |
| 1.2 | Clinical Center of Excellence | CCE | A NYMA-based medical facility that, in accordance with the Zadroga Act, operates under an individual contractual relationship with the WTC Health Program to provide medical monitoring, diagnosis, certification, treatment services, case management, and benefits counseling for members in the NY metropolitan area. Members residing in NYMA or otherwise electing care through a CCE are assigned a CCE which is responsible for coordinating their care under the WTC Health Program. The Zadroga Act defines a CCE as “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 WTC responders, screening-eligible WTC survivors, or certified-eligible WTC survivors; (ii) has experience in caring for WTC responders and screening-eligible WTC 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 benefits counseling; and (iv) meets such other requirements as specified by the Administrator.” See Zadroga Act Section 3305(b)(1)(A). |
| 1.2 | Comprehensive Cost Avoidance Contractor | CCA Contractor | A vendor that implements comprehensive cost avoidance functions, including recovering of funds from workers’ compensation programs and other health insurance (OHI) where the Program overpaid; facilitating Coordination of Benefits; and verifying member demographic information to improve efficiency and control healthcare costs without compromising quality of care. The Survivor CCE Contractor is not anticipated to have a direct relationship with the CCA. |
| 1.2 | Data Center | DC | A vendor that supports various functions, including receiving data from the CCEs, NPN, and HPS/TPA Contractor; developing examination, monitoring, and treatment protocols; and coordinating outreach activities. There are currently three DCs contracted with the Program, serving the FDNY, General Responder, and Survivor populations. |
| 1.2 | Health Program Evaluation Contractor | HPE Contractor | A vendor that provides consulting services for data analytics to support strategic planning and program evaluation. The Survivor CCE Contractor is not anticipated to have a direct relationship with the HPE Contractor. |
| 1.2 | Health Program Support/Third Party Administrator Contractor | HPS/TPA Contractor | A vendor that performs various Program functions, including processing member enrollment and certification applications, managing the customer-service call center, managing the provider network, administering benefit plans, processing medical claims, maintaining the member database, and coordinating member communications. |
| 1.2 | Nationwide Provider Network Administrator | NPN Administrator | A vendor that administers the Nationwide Provider Network—a nationwide network of healthcare providers that provides WTC-related healthcare, including initial health evaluation, monitoring, and treatment benefits to enrolled WTC Responders, screening-eligible Survivors, and certified-eligible Survivors who live outside the NYMA, and processes claims submitted by these providers for Program-authorized services. |
| 1.2 | Outreach and Education Contractor | O&E Contractor | A vendor that supports recruitment for potential members (both Responders and Survivors) by developing culturally and linguistically appropriate educational materials and conducting various outreach efforts. The Survivor CCE Contractor is not anticipated to have a direct relationship with the O&E Contractor. |
| 1.2 | Pharmacy Benefits Manager | PBM | A vendor that provides comprehensive pharmacy services to the WTC Health Program for filling prescriptions at retail and mail-order pharmacies, with controls on formularies, members, and prescribers. Pharmacy benefits are administered through a pharmacy-specific call center, claims adjudication, formulary management, pharmacy network management, and clinical reviews. |
| 2 | WTC-related health condition | RC | An illness or health condition for which exposure to airborne toxins, any other hazard, or any other adverse condition resulting from the September 11, 2001, terrorist attacks, based on an examination by a medical professional with expertise in treating or diagnosing the health conditions in the List of WTC-Related Health Conditions, is substantially likely to be a significant factor in aggravating, contributing to, or causing the illness or health condition, including a mental health condition. Only those conditions on the List of WTC-Related Health Conditions codified in 42 CFR 88.15 may be considered WTC-related health conditions. See 42 CFR 88.1.WTC-related Health Conditions must be certified by the WTC Health Program to receive treatment for that condition. |
| 3 | Health Insurance Portability and Accountability Act of 1996 | HIPAA | |
| 4 | Protected Health Information | PHI | |
| 4 | United States Department of Health and Human Services | HHS | |
| 4.10 | National Institute of Standards and Technology | NIST | |
| 4.1 | Start of Healthcare Delivery | SHCD | |
| 4.2 | Contract Management Plan | CMP | |
| 4.3 | Business Associate Agreement | BAA | |
| 4.3 | Claims Submission Lead | Oversees claims to ensure appropriate and timely claims submission and medical necessity review, per Section 4.8 | |
| 4.3 | Communications Lead | Coordinates broad stakeholder outreach, communication, education, and engagement to ensure plain language communications and consistency in messaging, per Section 4.4 | |
| 4.3 | Comprehensive Care Management Lead | Oversees case management and care coordination, per Section 4.7, and attends the case management forum meetings | |
| 4.3 | Data and Analytics Lead | Oversees completion of data use and interconnection security agreements, data engineering and governance, analytics, reporting and visualization, and testing and validation of system readiness, per Section 4.9.3 | |
| 4.3 | Eastern Time Zone | ET | |
| 4.3 | Fraud Officer | Oversees implementation of the Fraud, Waste, and Abuse Prevention, Detection, and Reporting Plan, per Section 4.11.2 | |
| 4.3 | Fraud, Waste, and Abuse | FWA | |
| 4.3 | HIPAA Compliance Officer | Oversees development of HIPAA privacy and security policies and procedures, to ensure compliance with HIPAA statutory and regulatory requirements, per Section 4.11.1 and the Business Associate Agreement | |
| 4.3 | Member Services Lead | Oversees handling of individual member inquiries/questions, education, and engagement, and all other operational processes listed in Section 4.5 | |
| 4.3 | Personally Identifiable Information | PII | |
| 4.3 | Pharmacy Services Lead | Oversees prescription management for members; troubleshoots prescription processing issues and conducts quality monitoring and reporting, per Section 4.6.8 | |
| 4.3 | Project Manager | Responsible for global project oversight; guides project execution and control through a formal documentation of project goals, objectives, scope, risks, and timelines (as captured in Transition-In Plan, CMP, TIMS, RAID Log, etc.) | |
| 4.3 | Provider Services Lead | Oversees handling of provider education and engagement per Section 4.3.2.1 to facilitate appropriate administration of healthcare benefits, as described in Section 4.6 | |
| 4.3 | Quality Management and Improvement Lead | Oversees quality monitoring, management, and improvement initiatives, per Section 4.2.6 | |
| 4.3 | Social Services Lead | Oversees benefits counseling, including financial counseling for members without Minimum Essential Coverage (MEC), per Section 4.5.6 | |
| 4.3 | System Security Officer | Oversees compliance and security of Contractor information technology systems; ensures appropriate safeguarding of Personally Identifiable Information and PHI, per Section 4.11.1 | |
| 4.3 | Transition-In Lead | Responsible for overall Transition-In | |
| 4.3 | Transition-Out Lead | Responsible for overall Transition-Out | |
| 4.6 | Health Condition Medically Associated with a WTC-Related Health Condition | MAC | |
| 4.6 | Treat a condition prior to certification | Treatment Pending Certification | While certification of a condition is pending, authorization for time-limited treatment of a WTC-related health condition or a health condition medically associated with a WTC-related health condition may be requested at the CCE/NPA's discretion. Such authorization must be obtained from the WTC Health Program before treatment is provided, except for the provision of treatment for a medical emergency, per Program regulations. In order for a CCE/NPA to provide treatment pending certification for a health condition, the condition must be eligible for treatment by the Program, a certification request must have been submitted to the Program but not yet adjudicated, the care delivered does not require a PA2 or PA3, the request for certification is ultimately granted, and the treatment provided is medically necessary, follows Program guidelines, and is rendered by a INN provider. This mechanism should only be used in clinically urgent and time-sensitive situations. |
| 4.7 | Case Management and Utilization Management Plan | CM/UM Plan | |
| 11.2 | System of Records Notice | SORN | |
| 11.4 | Paperwork Reduction Act | PRA | |
| 4.1.1 | Contracting Officer Representative | COR | |
| 4.1.2 | Monthly Progress Report | MPR | |
| 4.1.2 | Risk, Assumptions, Issues and Decisions Log | RAID Log | |
| 4.1.2 | Transition-In Master Schedule | TIMS | |
| 4.1.2 | Transition-In Progress Report | TIPR | |
| 4.1.3 | Data and Information Management Plan | DIM Plan | |
| 4.1.3 | Electronic Data Interchange | EDI | |
| 4.1.3 | Electronic Funds Transfer | EFT | |
| 4.1.3 | Quality Assurance Surveillance Plan | QASP | |
| 4.1.3 | September 11th Victim Compensation Fund | VCF | |
| 4.1.3 | Utilization Management | UM | |
| 4.1.3. | Performance Work Statement | PWS | |
| 4.1.5 | Contract Line Item Number | CLIN | |
| 4.1.5 | Transition-Out Master Schedule | TOMS | |
| 4.1.5 | WTC Health Program Information Security Officer | ISO | |
| 4.11.1 | Business Associate | Contractor as defined in 45 CFR 160.103 | |
| 4.11.1 | Business Associate Agreement | BAA | |
| 4.11.1 | Covered Entity | WTC Health Program and any other NIOSH, CDC, or HHS components to the extent that they assist in administering the WTC Health Program and where PHI is involved as defined in 45 CFR 160.103 | |
| 4.11.2 | Fraud, Waste, and Abuse Incident Report | FWA Incident Report | |
| 4.11.2 | Fraud, Waste, and Abuse Prevention and Detection and Reporting Plan | FWA Prevention, Detection, and Reporting Plan | |
| 4.2.1 | Change Request | CR | |
| 4.2.4 | Other Direct Costs | ODCs | |
| 4.2.6 | Semi-Annual Report | SAR | |
| 4.3 | Administrator | Responsible for overall contract management | |
| 4.3 | Clinical Director | Responsible for clinical and administrative oversight for all monitoring, diagnostics, screening and treatment services (including medications) and their adherence to medical policy, monitoring protocols, and medical necessity of rendered treatment; responsible for providing recommendations for the WTC Health Program and member population based on clinical expertise | |
| 4.3 | Mental Health Director | Responsible for clinical and administrative oversight for adherence to monitoring protocols and medical necessity for all rendered mental health diagnostic and treatment services; responsible for providing recommendations for the WTC Health Program and member population based on clinical expertise | |
| 4.3 | Transition-In Lead | Responsible for overall Transition-In | |
| 4.3 | Transition-Out Lead | Responsible for overall Transition-Out | |
| 4.3 | Project Manager | Responsible for global project oversight; guides project execution and control through a formal documentation of project goals, objectives, scope, risks, and timelines (as captured in Transition-In Plan, CMP, TIMS, RAID Log, etc.) | |
| 4.3 | Communications Lead | Coordinates broad stakeholder outreach, communication, education, and engagement to ensure plain language communications and consistency in messaging, per Section 4.4 | |
| 4.3 | Quality Management and Improvement Lead | Oversees quality monitoring, management, and improvement initiatives, per Section 4.2.6 | |
| 4.3 | Member Services Lead | Oversees handling of individual member inquiries/questions, education, and engagement, and all other operational processes listed in Section 4.5 | |
| 4.3 | Social Services Lead | Oversees benefits counseling, including financial counseling for members without Minimum Essential Coverage (MEC), per Section 4.5.6 | |
| 4.3 | Provider Services Lead | Oversees handling of provider education and engagement per Section 4.3.2.1 to facilitate appropriate administration of healthcare benefits, as described in Section 4.6 | |
| 4.3 | Pharmacy Services Lead | Oversees prescription management for members; troubleshoots prescription processing issues and conducts quality monitoring and reporting, per Section 4.6.8 | |
| 4.3 | Comprehensive Care Management Lead | Oversees case management and care coordination, per Section 4.7, and attends the case management forum meetings | |
| 4.3 | Claims Submission Lead | Oversees claims to ensure appropriate and timely claims submission and medical necessity review, per Section 4.8 | |
| 4.3 | Data and Analytics Lead | Oversees completion of data use and interconnection security agreements, data engineering and governance, analytics, reporting and visualization, and testing and validation of system readiness, per Section 4.9.3 | |
| 4.3 | HIPAA Compliance Officer | Oversees development of HIPAA privacy and security policies and procedures, to ensure compliance with HIPAA statutory and regulatory requirements, per Section 4.11.1 and the Business Associate Agreement (BAA) | |
| 4.3 | Fraud Officer | Oversees implementation of the Fraud, Waste, and Abuse (FWA) Prevention, Detection, and Reporting Plan, per Section 4.11.2 | |
| 4.3 | System Security Officer | Oversees compliance and security of Contractor information technology systems; ensures appropriate safeguarding of Personally Identifiable Information (PII) and PHI, per Section 4.11.1 | |
| 4.3.2.1 | External Provider Network | EPN | |
| 4.4.2 | Other Health Insurance | OHI | |
| 4.5.4 | Minimum Essential Coverage | MEC | |
| 4.5.6 | Benefits Eligibility Assessment and Screening Tool | BEAST | |
| 4.6.1 | Annual Monitoring Exam | AME | Detailed yearly health exam of a WTC Responder or Certified-Eligible Survivor that looks for WTC-related physical and mental health conditions. Findings help determine whether a member has a condition that can be certified for treatment in the WTC Health Program and are used for long-term health monitoring and analysis. It includes the same components as the Initial Health Evaluation and first Annual Monitoring Exam, except for the exposure assessment |
| 4.6.1 | Initial Health Evaluation | IHE | |
| 4.6.1 | Medical History Questionnaire | MHQ | |
| 4.6.3 | United States Preventive Services Task Force | USPSTF | |
| 4.7.1 | Prior Authorization | PA | |
| 4.8.1 | Centers for Medicare and Medicaid Services | CMS | |
| 4.8.1 | Diagnostic Related Group | DRG | |
| 4.8.1 | Federal Employees' Compensation Act | FECA | |
| 4.8.1 | Office of Workers' Compensation Programs, U.S. Department of Labor | OWCP | |
| 4.8.2 | American Dental Association | ADA | |
| 4.8.2 | Federal Payment Levy Program | FPLP | |
| 4.8.2 | Taxpayer Identification Numbers | TINs | |
| 4.9.1 | Quality Assurance | QA | |
| 4.9.3 | OHI/COB Report | Submitted every six months, this report shall provide statistics related to the collection of primary insurance for Survivors and those related to billing of personal health insurance (including percentage of claims submitted to OHI, percentage of claims paid by OHI, total savings, etc.). | |
| 4.9.3 | Outlier Semi-Annual Report | OSAR | Submitted every six months, this pharmacy outlier report shall demonstrate findings of reviews conducted by the Contractor during the reporting period and shall be used to mitigate FWA at the CCE based on guidance from the WTC Health Program Pharmacy Benefits Team (PBT). The Contractor shall document in this report any corrective actions done (e.g., provider outreach, member education, drug block, etc.) and shall respond in a timely manner to any follow-up comments from the PBT that require a response. |
| 4.9.3 | Semi-Annual Report | SAR | Submitted every six months, this report shall demonstrate findings of reviews conducted by the Contractor during the reporting period and should be used to improve activities at the CCE. |
| 4.9.3 | WTC Health Program Pharmacy Benefits Team | PBT | |
| 4.9.4 | Data Use Agreement | DUA | |
| 4.9.4 | Interconnection Security Agreement | ISA | |
| 4.9.7 | Data Management Plan | DMP | |
| 8.3.3 | Responsible, Accountable, Consulted, and Informed | RACI | |
| 8.3.5 | Monthly Progress Report | MPR | |
| ATT009_SurvivorCCE_TGD020_PartnerCommsPlans | Point of Contact | POC | |
| ATT020_SurvivorCCE_ReferenceGuide_CM_UM | Intensive Case Management | ICM | |
| ATT020_SurvivorCCE_ReferenceGuide_CM_UM | Level 2 Prior Authorization | PA2 | |
| ATT020_SurvivorCCE_ReferenceGuide_CM_UM | Plan of Care | POC | |
| Technical Guidance Document | TGD |
Sheet2
| Term | Description | Missing |
| Business Associate Agreement | American Dental Association | Match |
| Administrator | Annual Monitoring Exams | Missing |
| American Dental Association | Business Associate Agreement | Match |
| Annual Monitoring Exam | Benefits Eligibility Assessment and Screening Tool | Match |
| Benefits Eligibility Assessment and Screening Tool | Contractor as defined in 45 CFR 160.103 | Missing |
| Business Associate | BAA | Missing |
| Business Associate Agreement | Comprehensive Cost Avoidance Contractor | Match |
| Case Management and Utilization Management Plan | Clinical Center of Excellence | Match |
| Centers for Disease Control and Prevention | Clinical Center of Excellence | Match |
| Centers for Medicare and Medicaid Services | Centers for Disease Control and Prevention | Match |
| Change Request | Oversees claims to ensure appropriate and timely claims submission and medical necessity review, per Section 4.8 | Missing |
| Claims Submission Lead | Contract Line Item Number | Match |
| Claims Submission Lead | A NYMA-based medical facility that, in accordance with the Zadroga Act, operates under an individual contractual relationship with the WTC Health Program to provide medical monitoring, diagnosis, certification, treatment services, case management, and benefits counseling for members in the NY metropolitan area. Members residing in NYMA or otherwise electing care through a CCE are assigned a CCE which is responsible for coordinating their care under the WTC Health Program. The Zadroga Act defines a CCE as “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 WTC responders, screening-eligible WTC survivors, or certified-eligible WTC survivors; (ii) has experience in caring for WTC responders and screening-eligible WTC 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 benefits counseling; and (iv) meets such other requirements as specified by the Administrator.” See Zadroga Act Section 3305(b)(1)(A). | Match |
| Clinical Center of Excellence | Case Management and Utilization Management Plan | Match |
| Clinical Center of Excellence | Contract Management Plan | Match |
| Clinical Director | Centers for Medicare and Medicaid Services | Match |
| Communications Lead | Coordination of Benefits | Match |
| Communications Lead | Coordinates broad stakeholder outreach, communication, education, and engagement to ensure plain language communications and consistency in messaging, per Section 4.4 | Missing |
| Comprehensive Care Management Lead | Oversees case management and care coordination, per Section 4.7, and attends the case management forum meetings | Missing |
| Comprehensive Care Management Lead | A vendor that implements comprehensive cost avoidance functions, including recovering of funds from workers’ compensation programs and other health insurance (OHI) where the Program overpaid; facilitating Coordination of Benefits; and verifying member demographic information to improve efficiency and control healthcare costs without compromising quality of care. The Survivor CCE Contractor is not anticipated to have a direct relationship with the CCA. | Match |
| Comprehensive Cost Avoidance Contractor | Contracting Officer Representative | Match |
| Contract Line Item Number | WTC Health Program and any other NIOSH, CDC, or HHS components to the extent that they assist in administering the WTC Health Program and where PHI is involved as defined in 45 CFR 160.103 | Missing |
| Contract Management Plan | Change Request | Match |
| Contracting Officer Representative | Oversees completion of data use and interconnection security agreements, data engineering and governance, analytics, reporting and visualization, and testing and validation of system readiness, per Section 4.9.3 | Missing |
| Coordination of Benefits | A vendor that supports various functions, including receiving data from the CCEs, NPN, and HPS/TPA Contractor; developing examination, monitoring, and treatment protocols; and coordinating outreach activities. There are currently three DCs contracted with the Program, serving the FDNY, General Responder, and Survivor populations. | Match |
| Covered Entity | Data Center | Match |
| Data and Analytics Lead | Data and Information Management Plan | Match |
| Data and Analytics Lead | Data Management Plan | Match |
| Data and Information Management Plan | Diagnostic Related Group | Match |
| Data Center | Data Use Agreements | Missing |
| Data Management Plan | Electronic Data Interchange | Match |
| Data Use Agreement | Electronic Funds Transfer | Match |
| Diagnostic Related Group | NYMA External Provider Network | Missing |
| Eastern Time Zone | Eastern Time Zone | Match |
| Electronic Data Interchange | WTC Responder – FDNY Family Member | Missing |
| Electronic Funds Transfer | WTC Responder – affiliated with the Fire Department of the City of New York (FDNY) | Match |
| External Provider Network | Federal Employees Compensation Act | Missing |
| Federal Employees' Compensation Act | Federal Payment Levy Program | Match |
| Federal Payment Levy Program | Oversees implementation of the Fraud, Waste, and Abuse Prevention, Detection, and Reporting Plan, per Section 4.11.2 | Missing |
| Fraud Officer | Fraud, Waste, Abuse | Missing |
| Fraud Officer | Fraud, Waste, and Abuse Incident Report | Match |
| Fraud, Waste, and Abuse | Fraud, Waste, and Abuse Prevention and Detection and Reporting Plan | Match |
| Fraud, Waste, and Abuse Incident Report | A vendor that provides consulting services for data analytics to support strategic planning and program evaluation. The Survivor CCE Contractor is not anticipated to have a direct relationship with the HPE Contractor. | Missing |
| Fraud, Waste, and Abuse Prevention and Detection and Reporting Plan | A vendor that performs various Program functions, including processing member enrollment and certification applications, managing the customer-service call center, managing the provider network, administering benefit plans, processing medical claims, maintaining the member database, and coordinating member communications. | Match |
| Health Condition Medically Associated with a WTC-Related Health Condition | U.S. Department of Health and Human Services | Missing |
| Health Insurance Portability and Accountability Act of 1996 | Health Insurance Portability and Accountability Act of 1996 | Match |
| Health Program Evaluation Contractor | Oversees development of HIPAA privacy and security policies and procedures, to ensure compliance with HIPAA statutory and regulatory requirements, per Section 4.11.1 and the Business Associate Agreement | Missing |
| Health Program Support/Third Party Administrator Contractor | Health Program Evaluation Contractor | Match |
| Health Program Support/Third-Party Administrator | Health Program Support/Third-Party Administrator | Match |
| HIPAA Compliance Officer | Health Program Support/Third Party Administrator Contractor | Match |
| HIPAA Compliance Officer | Intensive Care Management | Missing |
| Initial Health Evaluation | Initial Health Evaluation | Match |
| Intensive Case Management | Interconnection Security Agreements | Missing |
| Interconnection Security Agreement | WTC Health Program Information Security Officer | Match |
| James Zadroga 9/11 Health and Compensation Act of 2010 | Health Condition Medically Associated with a WTC-Related Health Condition | Match |
| Level 2 Prior Authorization | Minimum Essential Coverage | Match |
| Medical History Questionnaire | Oversees handling of individual member inquiries/questions, education, and engagement, and all other operational processes listed in Section 4.5 | Missing |
| Member Services Lead | Medical History Questionnaire | Match |
| Member Services Lead | Monthly Progress Report | Match |
| Mental Health Director | Monthly Progress Report | Match |
| Minimum Essential Coverage | A vendor that administers the Nationwide Provider Network—a nationwide network of healthcare providers that provides WTC-related healthcare, including initial health evaluation, monitoring, and treatment benefits to enrolled WTC Responders, screening-eligible Survivors, and certified-eligible Survivors who live outside the NYMA, and processes claims submitted by these providers for Program-authorized services. | Match |
| Monthly Progress Report | National Institute for Occupational Safety and Health | Match |
| Monthly Progress Report | National Institute of Standards and Technology | Match |
| National Institute for Occupational Safety and Health | WTC Responder – not affiliated with FDNY | Missing |
| National Institute of Standards and Technology | Nationwide Provider Network | Match |
| Nationwide Provider Network | Nationwide Provider Network Administrator | Match |
| Nationwide Provider Network Administrator | New York City | Match |
| New York Metropolitan Area | New York Metropolitan Area | Match |
| New York City | Outreach and Education Contractor | Match |
| Office of Workers' Compensation Programs, U.S. Department of Labor | Other Direct Costs | Match |
| OHI/COB Report | Other Health Information | Missing |
| Other Direct Costs | Submitted every six months, this report shall provide statistics related to the collection of primary insurance for Survivors and those related to billing of personal health insurance (including percentage of claims submitted to OHI, percentage of claims paid by OHI, total savings, etc.). | Match |
| Other Health Insurance | Outlier Semi-Annual Report | Match |
| Outlier Semi-Annual Report | Submitted every six months, this pharmacy outlier report shall demonstrate findings of reviews conducted by the Contractor during the reporting period and shall be used to mitigate FWA at the CCE based on guidance from the WTC Health Program Pharmacy Benefits Team (PBT). The Contractor shall document in this report any corrective actions done (e.g., provider outreach, member education, drug block, etc.) and shall respond in a timely manner to any follow-up comments from the PBT that require a response. | Match |
| Outreach and Education Contractor | A vendor that supports recruitment for potential members (both Responders and Survivors) by developing culturally and linguistically appropriate educational materials and conducting various outreach efforts. The Survivor CCE Contractor is not anticipated to have a direct relationship with the O&E Contractor. | Match |
| Paperwork Reduction Act | Office of Workers' Compensation Programs, U.S. Department of Labor | Match |
| Pentagon and Shanksville, PA Responders | Prior Authorization | Match |
| Performance Work Statement | Level 2 Prior Authorization | Match |
| Personally Identifiable Information | Pharmacy Benefits Manager | Match |
| Pharmacy Benefits Manager | Pharmacy Benefits Manager | Match |
| Pharmacy Benefits Manager | WTC Health Program Pharmacy Benefits Team | Match |
| Pharmacy Services Lead | Fire or police department employees (fire or emergency personnel, active or retired), Department of Defense or other Federal agency employees and contractors, members of the regular or reserve uniformed services, recovery, or cleanup contractor workers, or volunteers, who performed rescue, recovery, demolition, debris cleanup, or other related services after the terrorist-related aircraft crashes on September 11, 2001, at the Pentagon in Arlington, VA, or in Shanksville, PA. As of March 2024, there are 1,161 Pentagon Responder and 143 Shanksville Responder members. | Match |
| Pharmacy Services Lead | A vendor that provides comprehensive pharmacy services to the WTC Health Program for filling prescriptions at retail and mail-order pharmacies, with controls on formularies, members, and prescribers. Pharmacy benefits are administered through a pharmacy-specific call center, claims adjudication, formulary management, pharmacy network management, and clinical reviews. | Match |
| Plan of Care | Oversees prescription management for members; troubleshoots prescription processing issues and conducts quality monitoring and reporting, per Section 4.6.8 | Missing |
| Point of Contact | Protected Health Information | Match |
| Prior Authorization | Personally Identifiable Information | Match |
| Project Manager | Point of Contact | Match |
| Project Manager | Plan of Care | Match |
| Protected Health Information | Paperwork Reduction Act | Match |
| Provider Services Lead | World Trade Center Health Program | Match |
| Provider Services Lead | Responsible for global project oversight; guides project execution and control through a formal documentation of project goals, objectives, scope, risks, and timelines (as captured in Transition-In Plan, CMP, TIMS, RAID Log, etc.) | Missing |
| Quality Assurance | Oversees handling of provider education and engagement per Section 4.3.2.1 to facilitate appropriate administration of healthcare benefits, as described in Section 4.6 | Missing |
| Quality Assurance Surveillance Plan | Performance Work Statement | Match |
| Quality Management and Improvement Lead | Quality Assurance | Match |
| Quality Management and Improvement Lead | Quality Assurance Surveillance Plan | Match |
| Responders | Oversees quality monitoring, management, and improvement initiatives, per Section 4.2.6 | Missing |
| Responsible, Accountable, Consulted, and Informed | Responsible, Accountable, Consulted, and Informed | Match |
| Risk, Assumptions, Issues and Decisions Log | Risk, Assumptions, Issues and Decisions Log | Match |
| Semi-Annual Report | WTC-related health condition | Match |
| Semi-Annual Report | Workers or volunteers who provided rescue, recovery, debris cleanup, and related support services on or in the aftermath of the September 11, 2001, terrorist attacks at the World Trade Center, the Pentagon, or the aircraft crash site near Shanksville, PA | Missing |
| September 11th Victim Compensation Fund | Semi-Annual Report | Match |
| Social Services Lead | Semi-Annual Report | Match |
| Social Services Lead | Submitted every six months, this report shall demonstrate findings of reviews conducted by the Contractor during the reporting period and should be used to improve activities at the CCE. | Missing |
| Start of Healthcare Delivery | Start of Healthcare Delivery | Match |
| Survivors | Oversees benefits counseling, including financial counseling for members without Minimum Essential Coverage (MEC), per Section 4.5.6 | Missing |
| System of Records Notice | System of Records Notice | Match |
| System Security Officer | Persons who were present in the New York City (NYC) Disaster Area in the dust or dust cloud on September 11, 2001, or who worked, resided, or attended school, childcare, or adult daycare in the NYC Disaster Area for a certain period following the September 11, 2001, terrorist attacks. | Match |
| System Security Officer | Oversees compliance and security of Contractor information technology systems; ensures appropriate safeguarding of Personally Identifiable Information and PHI, per Section 4.11.1 | Missing |
| Taxpayer Identification Numbers | Technical Guidance Document | Match |
| Technical Guidance Document | Transition-In Master Schedule | Match |
| Transition-In Lead | Taxpayer Identification Numbers | Match |
| Transition-In Lead | Transition-In Progress Report | Match |
| Transition-In Master Schedule | Transition-Out Master Schedule | Match |
| Transition-In Progress Report | Responsible for overall Transition-In | Missing |
| Transition-Out Lead | Responsible for overall Transition-Out | Missing |
| Transition-Out Lead | Treat a condition prior to certification | Match |
| Transition-Out Master Schedule | Utilization Management | Match |
| Treat a condition prior to certification | U.S. Preventive Services Task Force | Missing |
| United States Department of Health and Human Services | September 11th Victim Compensation Fund | Match |
| United States Preventive Services Task Force | The program established by Title XXXIII of the Public Health Service Act, as amended, 42 U.S.C. 300mm to 300mm-61 (codifying Title I of the James Zadroga 9/11 Health and Compensation Act of 2010 , Pub. L. 111-347, as amended by Pub. L. 114-113 and Pub. L. 116-59), to provide medical monitoring and treatment benefits for eligible responders to the September 11, 2001, terrorist attacks and initial health evaluation, monitoring, and treatment benefits for residents and other building occupants and area workers in New York City who were directly impacted and adversely affected by such attacks. See 42 CFR 88.1. | Match |
| Utilization Management | An individual (active or retired) who participated at least one day in the rescue and recovery effort at any of the former World Trade Center sites (including Ground Zero, Staten Island Landfill, and the New York City Chief Medical Examiner’s Office). As of March 2024, there are 17,059 FDNY Responder members. | Match |
| World Trade Center Health Program | A surviving immediate family member of an FDNY member (whether fire or emergency personnel, active or retired) who was killed at the World Trade Center site on September 11, 2001, and received any treatment for a WTC-related mental health condition on or before September 1, 2008. As of March 2024, there are 667 FDNY Family members. | Match |
| WTC Health Program Information Security Officer | An individual who worked or volunteered onsite in rescue, recovery, demolition, debris cleanup, or related support services in lower Manhattan (south of Canal St.), the Staten Island Landfill, or the barge-loading piers; a member of the Police Department of New York City (active or retired) or a member of the Port Authority Police of the Port Authority of New York and New Jersey (active or retired) who participated onsite in rescue, recovery, debris cleanup, or related services in lower Manhattan (south of Canal St.), including Ground Zero, the Staten Island Landfill, or the barge loading piers; an employee of the Office of the Chief Medical Examiner of New York City involved in the examination and handling of human remains from the World Trade Center attacks, or other morgue worker who performed similar post-September 11 functions for such Office staff; a worker in the Port Authority Trans-Hudson Corporation Tunnel; or a vehicle-maintenance worker who was exposed to debris from the former World Trade Center while retrieving, driving, cleaning, repairing, and maintaining vehicles contaminated by airborne toxins from the September 11, 2001, terrorist attacks. As of March 2024, there are 70,955 General Responder members. | Match |
| WTC Health Program Pharmacy Benefits Team | An individual present in the New York City Disaster Area in the dust or dust cloud on September 11, 2001; an individual who lived, worked, or went to school, childcare, or adult daycare in lower Manhattan south of Houston Street and certain parts of Brooklyn; certain cleanup and maintenance workers in the New York City Disaster Area; and certain residents and individuals whose place of employment were deemed eligible to receive certain grants from the Lower Manhattan Development Corporation. | Match |
| WTC Responder – affiliated with the Fire Department of the City of New York (FDNY) | An illness or health condition for which exposure to airborne toxins, any other hazard, or any other adverse condition resulting from the September 11, 2001, terrorist attacks, based on an examination by a medical professional with expertise in treating or diagnosing the health conditions in the List of WTC-Related Health Conditions, is substantially likely to be a significant factor in aggravating, contributing to, or causing the illness or health condition, including a mental health condition. Only those conditions on the List of WTC-Related Health Conditions codified in 42 CFR 88.15 may be considered WTC-related health conditions. See 42 CFR 88.1.WTC-related Health Conditions must be certified by the WTC Health Program to receive treatment for that condition. | Match |
| WTC Responder – Fire Department of the City of New York (FDNY) Family Member | James Zadroga 9/11 Health and Compensation Act of 2010 | Match |
| WTC Responder – not affiliated with Fire Department of the City of New York | Missing | |
| WTC Survivor | Missing | |
| WTC-related health condition |
File details come from the government source that posted it. Updated .