Policies and Procedures - World Trade Center Health Program

http://www.cdc.gov/wtc/policies.html[6/17/2015 4:58:05 PM]

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

WTC Health Program: Policies and Procedures

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Health Conditions Medically Associated with WTC-Related Health Conditions

Making a Determination about Exposure Aggravating Pre-Existing Aerodigestive Disorders

Malignant Neuroendocrine Neoplasms

Minimum Latency & Types or Categories of Cancer

Myeloid Malignancies

Policy and Procedures for Adding Non-Cancer Conditions To the List of WTC-Related Health Conditions

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

Policy and Procedures for Cancer Screening

Policy and Procedures for Certification of Physician Determinations for Aerodigestive and Cancer Health Conditions

Policy and Procedures for Coordination of Benefits for Treatment Costs for Non-Work-Related, Certified WTC-Related Health

Conditions: Coordination with Health Insurance

Policy and Procedures for Handling Submissions and Petitions to Add a Health Condition to the List of WTC-Related Health

Conditions

Policy and Procedures for Recoupment & Coordination of Benefits: Lump-Sum Workers' Compensation Settlements

Policy and Procedures for Recoupment & Coordination of Benefits: Workers’ Compensation Payment

Rare Cancers

Time Intervals for New Onset Aerodigestive Disorders

WTC Health Program—Notice of Privacy Practices

Policy and Procedures for Certification of Physician Determinations for Aerodigestive and Cancer Health

Conditions

(5 pages, 411 KB)

Issue Date: February 20, 2015

About this document: 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.

Minimum Latency & Types or Categories of Cancer

(12 pages, 624 KB)

Revised: January 6, 2015

About this document: 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

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Policies and Procedures - World Trade Center Health Program

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and hematopoietic cancers.

Previous versions:

Policy and Procedures for Recoupment: Lump-Sum Workers' Compensation Settlements

(5 pages, 344 KB)

Revised: January 4, 2015

About this document: 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).

Health Conditions Medically Associated with WTC-Related Health Conditions

(5 pages, 486 KB)

Revised: November 7, 2014

About this document: 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 version:

Policy and Procedures for Adding Non-Cancer Conditions To the List of WTC-Related Health Conditions 

(7 pages, 321 KB)

Revised Date: October 21, 2014 

About this document: This document describes the process for adding non- cancer conditions to the list of WTCRevised: November 7, 2014

(11 pages, 526 KB)

Revised: May 1, 2013

(9 pages, 512 KB) 

Issue Date: October 17, 2012

(4 pages, 344 KB) 

Revised: February 10, 2014

(5 pages, 450 KB) 

Issue Date: January 2, 2014

(4 pages, 376 KB) 
Policies and Procedures - World Trade Center Health Program

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related health conditions. 

Previous versions:

Policy and Procedures for Handling Submissions and Petitions to Add a Health Condition to the List of WTCRelated Health Conditions

(2 pages, 136 KB)

Issue Date: May 14, 2014

About this document: 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 Types of Cancer To the List of WTC-Related Health Conditions 

(6 page, 187 KB)

Issue Date: May 14, 2014

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

Rare Cancers

(1 page, 247 KB)

Issue Date: May 5, 2014

About this document: This document defines and lists WTC-related health conditions in the category of "Rare

Cancers." 

Policy and Procedures for Cancer Screening 

(4 pages, 348 KB)

Issue Date: April 2, 2014

About this document: This document describes the purpose and procedure for cancer screening 

Policy and Procedures for Coordination of Benefits for Treatment Costs for Non-Work-Related, Certified

WTC-Related Health Conditions: Coordination with Health Insurance

(7 pages, 359 KB)

Revised: February 18, 2014 

About this document: 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. 

Revised: September 2, 2014

(6 pages 352 kb)

Revised: May 14, 2014

(6 pages, 158 KB)

Issue Date: March 21, 2014

(6 pages, 352 KB)
Policies and Procedures - World Trade Center Health Program

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Previous versions:

Myeloid Malignancies

(9 pages, 381 KB)

Issue Date: February 1, 2014 

About this document: Beginning on February 1, 2014, the World Trade Center (WTC) Health Program will consider

blood or bone marrow disorders of the myeloid line to be slow-growing blood cancers. Accordingly, they will be

considered WTC-related health conditions, making them available for WTC Health Program medical treatment services

for eligible members. These cancers had been considered non-malignant by the Administrator because they were

referred to as “pre-leukemic” hematopoietic disorders in the medical literature. Recent scientific advances, however,

characterize these “pre-leukemic” myeloid neoplasms as slow-growing blood cancers, and authoritative scientific sources

now consider them to be malignant myeloid neoplasms.

Policy and Procedures for Recoupment & Coordination of Benefits: Workers’ Compensation Payment

(14 pages, 288 KB)

Revised: December 16, 2013

About this document: 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 WTC Health Program is delaying the effective date for the component of the policy and procedures relating to

recoupment from lump sum settlements of workers’ compensation cases. The policy was originally scheduled to apply to

any lump sum settlement entered into after September 1, 2013. The recoupment policy will now apply to proposed

settlement agreements filed with the New York Workers’ Compensation Board (NY WCB) on or after October 1, 2013.

Any proposed settlement filed with the NY WCB on or after October 1, 2013, and which releases an employer/insurer’s

liability for any future medical expenses must be reviewed by the WTC Health Program or the parties may be financially

responsible for treatment expenses. The effective date for the policy as it relates to active workers’ compensation cases

where the claimant has not filed a lump sum settlement remains September 1, 2013.

Previous versions:

FAQs regarding Recoupment & Coordination of Benefits regarding Workers' Compensation Payment can be found on the

FAQ page. 

Time Intervals for New Onset Aerodigestive Disorders

(14 pages, 477 KB) 

Revised: February 18, 2015

Issue Date: February 1, 2014

(7 pages, 350 KB) 

Revised: October 1, 2013

(13 pages, 508 KB)

Issue Date: September 1, 2013

(14 pages, 288 KB)
Policies and Procedures - World Trade Center Health Program

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Page last reviewed: June 5, 2012 | Page last updated: February 20, 2015

About this document: 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

Making a Determination about Exposure Aggravating Pre-Existing Aerodigestive Disorders

(4 pages, 326 KB) 

Revised: February 18, 2015

About this document: 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:

Malignant Neuroendocrine Neoplasms

(4 pages, 352 KB) 

Issue Date: October 4, 2013

About this document: This document provides information regarding the certification of malignant neuroendocrine

neoplasm as a “rare cancer,” regardless of the anatomic site where identified. Each determination of any malignant

neoplasm must be considered for certification as a WTC-related health condition under the minimum latency

requirements for solid cancers, and the exposure requirements specified by the WTC Health Program in the WTC-3

Certification Request form.

WTC Health Program—Notice of Privacy Practices

(3 pages; 289 KB)

Issue Date: September 30, 2013 

About This Document: 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. 

Issue Date: December 16th, 2013

(14 pages, 535 KB)

Issue Date: November 7, 2014

(4 pages, 333 KB)