Policies and Procedures

Listed below are the policies used by the WTC Health Program:

Adding to the List of WTC-Related Health Conditions

Policy and Procedures for Handling Submissions and Petitions to Add a Health Condition to the List of WTC-Related Health Conditions [PDF, 2 pages, 136 KB]

Issue Date: May 14, 2014

This document describes the process for handling submissions and petitions for adding a health condition to the list of WTC-related health conditions.

Policy and Procedures for Adding Non-Cancer Conditions to the List of WTC-Related Health Conditions
[PDF, 25 pages, 335 KB]

Revised: October 18, 2024

This document describes the process for adding non-cancer conditions to the list of WTC-related health conditions.

Previous Versions:

Revised: July 5, 2023 [PDF, 19 pages, 704 KB]
Revised: September 11, 2019 [PDF, 19 pages, 348 KB]
Updated: May 1, 2019 [PDF, 13 pages, 249 KB]
Revised: February 14, 2017 [PDF, 13 pages, 342 KB]
Revised: May 11, 2016 [PDF, 8 pages, 342 KB]
Revised: October 21, 2014 [PDF, 7 pages, 321 KB]
Revised: May 14, 2014 [PDF, 6 pages, 158 KB]
Issue Date: March 21, 2014 [PDF, 6 pages, 352 KB]

Flowchart: Procedures for Adding Non-Cancer Health Conditions to the List of WTC-Related Health Conditions [PDF, 1 page, 2.6 MB, Print Only]

Policy and Procedures for Adding Types of Cancer To the List of WTC-Related Health Conditions
[PDF, 9 pages, 303 KB]

Updated: November 18, 2021

Policy and Procedures for Adding Types of Cancer to the List of WTC-Related Health Conditions.

Previous Versions:
- Issue Date: May 11, 2019 [PDF, 8 pages, 222 KB]
- Issue Date: May 11, 2016 [PDF, 8 pages, 458 KB]
- Issue Date: May 14, 2014 [PDF, 6 pages, 187 KB]
Development of the Inventory of 9/11 Agents [PDF, 36 pages, 977 KB]

Issue date: July 17, 2018

The World Trade Center (WTC) Health Program (Program) has developed an Inventory of 9/11 Agents (Inventory) that the Program will use for administrative purposes.

Aerodigestive Disorders

Making a Determination about Exposure Aggravating Pre-Existing Aerodigestive Disorders
[PDF, 4 pages, 326 KB]

Revised: February 18, 2015

This document provides information for CCE and NPN physicians about making a determination that 9/11 exposure resulted in aggravating an aerodigestive disorder that existed on September 11, 2001.

Aggravating the pre-existing health condition results in the aerodigestive disorder requiring 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 the individual’s 9/11 exposure.

Previous Versions:
- Issue Date: November 7, 2014 [PDF, 4 pages, 333 KB]
Policy and Procedures for Certification of Physician Determinations for Aerodigestive and Cancer Health Conditions [PDF, 5 pages, 411 KB]

Issue Date: February 20, 2015

This document is based on applicable sections of the James Zadroga 9/11 Health and Compensation Act of 2010 (“Zadroga Act”) and 42 C.F.R. Part 88 and defines the policies and procedures for physicians regarding the certification determinations for aerodigestive and cancer health conditions.
Time Intervals for New Onset Aerodigestive Disorders [PDF, 15 pages, 330 KB]

Revised: August 30, 2017

The Administrator of the World Trade Center (WTC) Health Program has determined that no minimum time interval will be applied to the five categories of new onset aerodigestive disorders that meet the temporal sequence of symptoms requirement for certification of a WTC-related health condition.

Previous Versions:
- Issue Date: February 18, 2015 [PDF, 14 pages, 477 KB]
- Issue Date: December 16th, 2013 [PDF, 14 pages, 535 KB]

Cancer

Rare Cancers [PDF, 1 page, 247 KB]

Issue Date: May 5, 2014

This document defines and lists WTC-related health conditions in the category of "Rare Cancers."
Minimum Latency & Types or Categories of Cancer [PDF, 12 pages, 624 KB]

Revised: January 6, 2015

As new scientific information becomes available to the WTC Program Administrator on minimum latencies for the types or categories of cancers on the List of WTC-Related Health Conditions found at 42 C.F.R. § 88.1, minimum latencies may be modified. The Administrator's May 1, 2013, revision to the White Paper on Minimum Latency & Types or Categories of Cancer changes minimum latencies for mesothelioma and the category of lymphoproliferative and hematopoietic cancers.

Previous Versions:
- Revised: November 7, 2014 [PDF, 11 pages, 526 KB]
- Revised: May 1, 2013 [PDF, 9 pages, 512 KB]
- Issue Date: October 17, 2012 [PDF, 4 pages, 344 KB]

Policy and Procedures for Cancer Screening [PDF, 4 pages, 138 KB]

Issue Date: April 2, 2014

This document describes the purpose and procedures for cancer screening.

Coverage of Drugs

Coverage of Drugs [PDF, 9 pages, 314 KB]

Issue Date: January 9, 2024

This document describes the WTC Health Program’s policy for determining which drugs are eligible for coverage. Once a drug is approved as eligible, it is added to the WTC Health Program Pharmacy Formulary. Certain restrictions may apply to formulary drugs, such as but not limited to, prior authorization criteria and quantity limits. In some limited circumstances, a drug that has not met the criteria for inclusion in the WTC Health Program Pharmacy Formulary may be eligible for coverage by the Program if certain other criteria are met.

Medically Associated Health Conditions

Health Conditions Medically Associated with WTC-Related Health Conditions [PDF, 5 pages, 486 KB]

Revised: November 7, 2014

This document provides information for Clinical Center of Excellence (CCE) and Nationwide Provider Network (NPN) physicians about the determination and certification of health conditions found to be medically associated with a certified WTC-related health condition and therefore eligible for coverage by the World Trade Center (WTC) Health Program.

Previous Versions:
- Revised: February 10, 2014 [PDF, 5 pages, 450 KB]
- Issue Date: January 2, 2014 [PDF, 4 pages, 376 KB]
Evidence of Concluding Dates for Pentagon-Shanksville Response [PDF, 70 pages, 907 KB]

February 18, 2012
This document: (1) identifies the important response and cleanup events after the attacks at the Pentagon and Shanksville sites, (2) identifies the dates that response cleanup activities ended at the Pentagon and Shanksville sites, and (3) provides information on the potential exposures to responders and volunteers during response and cleanup activities at the Pentagon and Shanksville sites after the attacks.

Payer Order Guidance

Policy and Procedures for World Trade Center (WTC) Health Program Identification and Payer Order Guidance for Medicare and Medicaid[PDF, 7 pages; 215 KB]

Issue Date: November 21, 2023

This document defines the payer order for treatment services, including pharmaceuticals, for World Trade Center (WTC) Health Program members in accordance with the Zadroga Act. It also provides Medicare Part D sponsors and state Medicaid plans guidance for coordinating benefits with the WTC Health Program. While Medicaid acts as the payer of last resort for most services, certain exceptions may apply.

Privacy Practices

WTC Health Program—Notice of Privacy Practices [PDF, 4 pages; 731 KB]

Issue Date: January 23, 2024

This notice describes how medical information about WTC Health Program members may be used and disclosed and how WTC Health Program members can get access to this information.

Foreign Language Versions:
Previous Versions:
- Issue Date: September 23, 2020 [PDF, 4 pages; 269 KB]
- Issue Date: December 15, 2016 [PDF, 3 pages; 289 KB]
- Issue Date: September 30, 2013 [PDF, 3 pages; 289 KB]

Recoupment and Coordination of Benefits

Policy and Procedures for Coordination of Benefits for Treatment Costs for Non-Work-Related, Certified WTC-Related Health Conditions: Coordination with Health Insurance [PDF, 7 pages, 359 KB]

Revised: February 18, 2014

This document defines the policies and procedures to be used by the World Trade Center (WTC) Health Program to coordinate benefits for treatment costs for non-work related, certified WTC-related health conditions with health insurance programs. These Policy and Procedures are effective on March 31, 2014, except Section IV, pertaining to the maintenance of minimum essential health insurance coverage, which is effective on July 1, 2014.

Previous Versions:
- Issue Date: February 1, 2014 [PDF, 7 pages, 350 KB]
Policy and Procedures for Recoupment: Lump-Sum Workers' Compensation Settlements [PDF, 7 pages, 337 KB]

Revised: July 7, 2016

This document restates and revises the policy regarding lump sum settlements that has been in effect since October 1, 2013, and was included in the earlier Policy and Procedures for Recoupment & Coordination of Benefits: Workers' Compensation Payment dated September 1, 2013 (as revised on October 1, 2013 and December 16, 2013) .

When a World Trade Center (WTC) Health Program member accepts a lump-sum settlement for a workers' compensation (WC) claim relating to conditions for which treatment is provided by the WTC Health Program, and that settlement releases an employer/insurer from responsibility for future medical expenses, the WTC Health Program will seek to recoup its costs of providing health care either from the member or from the individual/entity designated to administer any set-aside established to pay future medical expenses.3 The WTC Health Program will follow best practices for WC recoupment as outlined by the Centers for Medicare & Medicaid Services (CMS).

Previous Versions:
- Revised: January 4, 2015 [PDF, 5 pages, 344 KB]
Policy and Procedures for Recoupment & Coordination of Benefits: Workers’ Compensation Payment [PDF, 5 pages, 392 KB]

Revised: August 3, 2016

This document defines the policies and procedures to be used by the World Trade Center (WTC) Health Program to identify and seek recoupment of funds from workers’ compensation when available. It imposes duties on Responders, Clinical Centers of Excellence, Workers’ Compensation Insurers and other employers providing illness and injury benefits to Responders.

The effective date of this document is August 3, 2016. This Policy supersedes an earlier version of this document that went into effect on September 1, 2013 and was revised on December 16, 2013.

Contracts between the World Trade Center (WTC) Health Program and the Clinical Centers of Excellence (CCEs) and the Nationwide Provider Network (NPN) require the CCEs and NPN to seek recoupment from workers’ compensation (WC) insurers when such insurers have been identified by the CCE and the NPN. CCEs and the NPN will no longer have a duty to bill primary WC insurers. The WTC Health Program will rely on the Health Insurers’ Match Program (HIMP), authorized under New York State (NYS) law to recover payments from WC insurers. To facilitate recoupment, the WTC Health Program has entered into a contract to recover money retrospectively from NYS WC insurers.

Previous Versions:
- Revised: December 16, 2013 [PDF, 14 pages, 288 KB]
- Revised: October 1, 2013 [PDF, 13 pages, 508 KB]
- Issue Date: September 1, 2013 [PDF, 14 pages, 288 KB]
FAQs regarding Recoupment & Coordination of Benefits regarding Workers' Compensation Payment can be found on the FAQ page.

Transportation Services

Policy and Procedures for Non-Emergency General and Medical Transportation Services [PDF, 6 pages, 531 KB]

Issue Date: January 18, 2018

This document defines the policies and procedures to be used by the World Trade Center (WTC) Health Program for Coverage of Non-Emergency General and Medical Transportation Services, effective on January 18, 2018.
Medical Coverage Determination for Non-Emergency General Transportation Services for Members Assigned to the NPN [PDF, 6 pages, 159 KB]

Revised: October 3, 2019

This document defines the policies and procedures to be used by the World Trade Center (WTC) Health Program for Coverage of Non-Emergency General Transportation Services, and Expenses Incident to Non-Emergency General Transportation Services, for Members Assigned to the NPN, which is effective on January 18, 2018.

Previous Versions:
- Revised: May 15, 2019 [PDF, 6 pages, 534 KB]
- Revised: February 27, 2018 [PDF, 5 pages, 526 KB]
Medical Coverage Determination for Non-Emergency Medical Transportation Services for Members Assigned to the CCEs and NPN [PDF, 6 pages, 629 KB]

Issue Date: February 27, 2018

This document defines the policies and procedures to be used by the World Trade Center (WTC) Health Program for Coverage of Medically Necessary, Non-Emergency Medical Transportation Services for Clinical Centers of Excellence (CCE) and Nationwide Provider Network (NPN) Members, which is effective on January 18, 2018