Glossary for the WTC Health Program

Administrator (the Administrator of the WTC Health Program):

The Director of the National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention (CDC) in the Department of Health and Human Services (HHS), or his or her designee. The Administrator is the person responsible for overseeing and administering the Program.

Affiliated Provider:

Outside providers must be associated with a CCE or the NPN in order to provide care covered by the Program.

Appeal:

To formally challenge a decision made by the Program to not enroll an applicant or to disenroll a member, to not certify a health condition or to decertify a health condition, or to not cover a treatment.

Annual Monitoring Exam:

Also called Medical Monitoring Exam; 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 (approved) for treatment in the WTC Health Program.

Benefits Counseling:

A service available to members where a WTC Health Program staff person informs you about various benefits outside of the Program that you might be eligible for and assists you to apply for those benefits.

Centers for Medicare and Medicaid Services (CMS):

The Federal agency that administers the Medicare and Medicaid programs; CMS assists the WTC Health Program with payment functions.

Certification:

A decision by the WTC Health Program that your health condition is included on the List of WTC-Related Health Conditions, that your health condition and 9/11 exposures meet Program policies, and that your 9/11 exposures are substantially likely to have been a significant factor in aggravating, contributing to, or causing the health condition.

Certified:

A certified WTC-related health condition (or medically associated health condition) is one that has been approved for coverage by the Program based on the approval of a certification request for that condition.

Certified-Eligible Survivor

A Survivor with a certified WTC-related health condition(s). These members are eligible for annual monitoring exams and treatment for certified WTC-related and medically associated health condition(s).

Clinical Center of Excellence (CCE):

A medical center under contract with the WTC Health Program to provide WTC-related health services to members.

Coordination of Benefits:

A process that helps determine who pays a medical bill first when there is more than one potential payer.

Designated Representative:

A person that you choose to represent your interests in the Program. They can represent your interests in Program administrative processes, including during an appeal.

Durable Medical Equipment (DME):

Medical equipment used in a member’s home, such as CPAP machines and wheelchairs.

EKG:

Abbreviation for electrocardiogram. An electrocardiogram is a medical test used to look at and record the electrical activity of your heart.

Formulary:

A list of prescription drugs covered by the Program. The CCEs and the NPN are given updated lists periodically.

Fraud:

Intentional deception or misrepresentation by an individual or entity with knowledge that the misrepresentation could result in an unauthorized benefit to the individual, the entity, or some other third party.

Ground Zero:

A site in Lower Manhattan bound by Vesey Street to the north, the West Side Highway to the west, Liberty Street to the south, and Church Street to the east in which stood the former World Trade Center complex.

Health Insurance Portability and Accountability Act of 1996 (HIPAA):

A federal law that established national privacy standards for the protection of personal health information (called “protected health information” or PHI under HIPAA) given to and used by health care entities such as health plans, hospitals, clinics, and doctors. The law outlines how your PHI can be disclosed to other entities and when your consent is required. Learn more about your rights under HIPAA .

Home Health Services:

Healthcare services you receive in your home. These services are delivered according to a plan written by your healthcare provider.

Hospice Care:

Special services provided to an individual with a terminal illness. Hospice care addresses the medical, physical, social, emotional, and spiritual needs of a terminally ill person. Hospice also provides care and rest services to caregivers and family members.

Initial Health Evaluation:

Also called a baseline monitoring exam for Responders; Assessment of one or more symptoms that may be associated with a WTC-related health condition to evaluate whether a new member has a WTC-related health condition and is eligible for treatment under the Program. This exam includes a medical and exposure history, a physical examination, and additional medical testing as needed.

Inpatient:

A patient who is admitted to a healthcare facility, like a hospital or skilled nursing facility, for treatment that requires at least one overnight stay.

Inpatient Care:

Healthcare you get when you are admitted to a health care facility, like a hospital or skilled nursing facility.

James Zadroga 9/11 Health and Compensation Act (Zadroga Act):

Public Law 111-347 passed by the U.S. Congress in 2010 that created the WTC Health Program. The Zadroga Act provided funding for monitoring, medical and mental health treatment, and research for WTC Responders and Survivors. The Zadroga Act also reopened the September 11th Victim Compensation Fund (VCF).

Latency:

The amount of time that has passed between your earliest 9/11 exposures and the date you were first diagnosed with a health condition.

Level 1 Authorization:

When your WTC Health Program provider can decide that your needed treatment or medical service can be covered by the Program without having to seek permission from anyone else in the Program.

Level 2 Prior Authorization:

When your WTC Health Program provider must request permission from your CCE or the NPN Medical Director for your needed treatment or medical services to be covered by the Program. .

Level 3 Prior Authorization:

When your WTC Health Program provider must request permission from the WTC Health Program administration for your needed treatment or medical services to be covered by the Program.

List of WTC-Related Health Conditions (List):

Mental and physical health conditions eligible for coverage in the WTC Health Program identified in the Zadroga Act and Program regulations at 42 C.F.R. § 88.15.

Logistics Health Incorporated (LHI):

The organization that manages the Nationwide Provider Network and manages Program health care for members who live outside of the NY metropolitan area.

Mammogram:

An X-ray of the breast.

Managed Care Advisors (MCA)-Sedgwick:

The two organizations that together administer the Nationwide Provider Network (August 2022 to present) and manage Program health care for members who live outside of the NY metropolitan area. Sedgwick is MCA's parent company.

Maximum Time Interval:

For certain aerodigestive health conditions, the maximum amount of time that could have gone by between your last 9/11 exposure and the onset of symptoms of your WTC-related health condition.

Medicaid:

A joint Federal/state public health insurance program that covers medical costs for some people with low incomes and/or disabilities.

Medical Benefits Team:

The WTC Health Program staff who oversee medical benefits for Program members and make initial decisions about treatment authorizations for members.

Medical Emergency:

A serious medical or mental health condition for which immediate treatment is necessary (it would result in a threat to life, limb or sight, or when a person is at immediate risk to self or others).

Medically Associated Health Condition:

A health condition that results from treatment of a certified WTC-related health condition or results from the progression of a certified WTC-related health condition. A medically associated health condition must be certified as WTC-related by the Program in order to be eligible for coverage.

Medically Necessary Treatment:

Services by physicians and other health care providers, including diagnostic and laboratory tests, prescription drugs, inpatient and outpatient hospital services, and other care that is appropriate to manage, improve, or cure a certified WTC-related health condition or a medically associated health condition.

Medicare:

A Federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with endstage renal disease.

Member:

A WTC Responder or WTC Survivor who has been found eligible for the Program and enrolled.

Minimum Latency Requirement:

The shortest amount of time that could have passed between your earliest 9/11 exposure and the date you were first diagnosed with a cancer in order for your cancer to be covered by the Program.

Nationwide Provider Network (NPN):

A nationwide network of health care providers across the country under contract with the Program to provide WTC-related health care for Program members who live outside the NY metropolitan area and want to receive their WTC-related health care locally.

Network:

The health care providers, facilities, and pharmacies the Program has contracted with to provide you with health care services covered by the Program.

New York City (NYC) Disaster Area:

The area within New York City that is the area of Manhattan south of Houston Street, and any block in Brooklyn wholly or partially contained within a 1.5 mile radius of the former WTC complex.

New York (NY) Metropolitan Area:

An area specified by the Administrator to include portions of New York, New Jersey, Connecticut, and Pennsylvania; Program members residing within the area may access CCEs for their WTC-related health care.

National Institute for Occupational Safety and Health (NIOSH):

The federal agency that administers the WTC Health Program. NIOSH is part of the Centers for Disease Control and Prevention (CDC), in the U.S. Department of Health and Human Services (HHS).

Petition:

A formal written request to the Administrator to add a health condition to the List of WTC-Related Health Conditions.

Preferred Medication:

An available brand name drug chosen by healthcare experts to be most effective in treating a condition at the lowest cost. Preferred medications are used when a generic version of a drug is unavailable.

Primary Health Insurance:

Whatever private or public health insurance you have. Private insurance may include employer-sponsored health insurance or insurance purchased from the health insurance marketplace. Public insurance may include Medicare or Medicaid coverage. Some individuals may have a mix of both private and public insurance. The WTC Health Program is a limited health care benefits program that provides monitoring and treatment for certified WTC-related health conditions only. The Zadroga Act requires all members to maintain minimum essential health insurance coverage outside of the Program.

Screening-Eligible Survivor:

An individual who meets the WTC Survivor eligibility criteria and has symptoms of a WTC-related health condition. Upon enrollment in the Program, a Screening-Eligible Survivor is eligible for a one-time, initial health evaluation paid for by the Program.

September 11th Victim Compensation Fund (VCF):

A Program administered by the U.S. Department of Justice that provides compensation for economic and non-economic loss to individuals who were physically injured, or made physically ill, or relatives of deceased individuals who were killed, as a result of the terrorist-related aircraft crashes on September 11, 2001. Learn more at www.vcf.gov or 1-855-885-1555.

Skilled Nursing Facility:

A nursing facility with the staff and equipment needed to provide skilled nursing care.

Urgent Care:

Medically necessary services required for an illness or injury that would not result in further disability or death if not treated immediately but requires professional attention within 24 hours.

U.S. Preventive Services Task Force (USPSTF):

An independent, volunteer panel of national experts in disease prevention and evidence-based medicine. The USPSTF works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services. Learn more at www.uspreventiveservicestaskforce.org

Workers’ Compensation:

An insurance plan that employers are required to have to cover workers who get sick or injured on the job. It can provide injured or ill workers with medical and compensation benefits.

World Trade Center (WTC) Health Program (Program):

The Program established by Title XXXIII of the Public Health Service Act as amended, 42 U.S.C. §§ 300mm through 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)),to provide medical monitoring and treatment benefits for eligible responders and survivors of the September 11, 2001, terrorist attacks.

WTC-3 Certification Package:

Paperwork completed by your Program doctor to request certification of your WTC-related health conditions by the Program. It includes information about you, your health condition(s), and your 9/11 work and exposures.

WTC Health Registry:

A study run by the New York City Department of Health and Mental Hygiene to document and evaluate the long-term physical and mental health effects of 9/11. Learn more at www1.nyc.gov/site/911health/about/wtc-health-registry.page

WTC-related Health Condition:

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, 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 or mental health condition. Only those conditions on the List of WTC-Related Health Conditions codified in 42 C.F.R. § 88.15 may be considered WTC-related health conditions and a health condition must be certified by the Program to be eligible for coverage.

WTC Responder:

Workers or volunteers who provided rescue, recovery, debris cleanup, and related support services on or in the aftermath of the September 11, 2001 attacks for certain amounts of time during the period between September 11, 2001 and July 31, 2002. There are three groups of Responders in the WTC Health Program: FDNY Responders (and surviving FDNY family members); WTC General Responders (including NYPD); and Pentagon and Shanksville, PA Responders. Learn more at cdc.gov/wtc/eligiblegroups.html

WTC Survivor:

Also known as NYC Survivors; Includes individuals who were present in NYC Disaster Area in the dust or dust cloud on September 11, 2001; individuals who lived, worked or went to school or childcare, or adult child care in the NYC Disaster area for a certain amount of time during the period between September 11, 2001 and July 31, 2002; certain cleanup and maintenance workers; and certain individuals eligible (or whose place of employment was eligible) to receive certain grants from the Lower Manhattan Development Corporation. Learn more at www.cdc.gov/wtc/eligiblegroups.html