WTC Health Program: Information about the addition of Cancer

Document Summary
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General Public
: The Administrator of the World Trade Center (WTC) Health Program has added several types of cancers to the List of WTC-Related Health Conditions covered in the WTC Health Program established by the James Zadroga 9/11 Health and Compensation Act of 2010.  Read the informational fact sheet.
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Program Members
: The Administrator of the World Trade Center (WTC) Health Program has added several types of cancers to the List of WTC-Related Health Conditions covered in the WTC Health Program established by the James Zadroga 9/11 Health and Compensation Act of 2010.  Read the informational fact sheet.
pdf icon Physician Guidance: The final rule adding over 50 types of cancer to the List of WTC-Related Health Conditions is now effective.

Instructions:This document provides direction to the WTC Health Program physician to help them make a determination of a new WTC-related health condition. This document should not be used by anyone other than a WTC Health Program physician at a Clinical Center of Excellence or within the Nationwide Provider Network. Read the guidance. (updated June 19, 2013).

Cancer FAQ's

What cancers are covered by the WTC Health Program?
The Administrator added the following types of cancers:

  • Mesothelioma

  • Childhood cancers—Any type of cancer diagnosed in a person less than 20 years of age occurring after 9/11/01.

  • Rare cancers—any type of cancer which occurs at a rate less than 15 cases per 100,000 people per year (called the "incidence rate"). Every cancer submitted for certification is reviewed by the WTC Health Program to assess if that cancer meets the definition of a rare cancer.

    As of, March 27, 2014, the WTC Health Program certified the following health conditions as rare cancers:
    • Adrenal
    • Central Nervous System
    • Gallbladder/Biliary Tract
    • Gastrointestinal Stromal
    • Male Breast
    • Neuroendocrine
    • Penis
    • Small Intestine
    • Testis
    • Thymus

    This list only includes rare cancers certified as of the date listed and is not a comprehensive list of all of the types of cancers that are considered rare. You should discuss whether a specific type of cancer meets the rare cancer criteria with your WTC Health Program physician at your Clinical Center of Excellence or Nationwide Provider Network.

  • Malignant neoplasms of the following:
    • Lip, tongue, salivary gland, floor of mouth, gum and other mouth, tonsil, oropharynx, hypopharynx, and other oral cavity and pharynx.
    • Nasopharynx
    • Nose, nasal cavity, middle ear and accessory sinuses
    • Larynx
    • Esophagus
    • Stomach
    • Colon and rectum
    • Liver and intrahepatic bile duct
    • Retroperitoneum, peritoneum, omentum and mesentery
    • Trachea; bronchus and lung; heart, mediastinum and pleura; and other ill-defined sites in the respiratory system and intrathoracic organs
    • Soft tissues (sarcomas)
    • Skin (melanoma and non-melanoma), including scrotal cancer
    • Breast
    • Ovary
    • Urinary bladder
    • Kidney
    • Renal pelvis, ureter and other urinary organs
    • Eye and orbit
    • Thyroid
    • Blood and lymphoid tissues (including, but not limited to, lymphoma, leukemia, and myeloma)
    • Prostate

The above covered cancers will be added to the WTC Health Program “List of WTC-Related Health Conditions” as of October 12, 2012. The “List of WTC-Related Health Conditions” is the list of physical and mental illnesses that are covered by the WTC Health Program.

What is a childhood cancer?

For the WTC Health Program, the term “childhood cancer” means any type of cancer first diagnosed after 9/11/01 in a person less than 20 years of age at the time of diagnosis.

What does it mean for my cancer to be “covered” by the WTC Health Program?
“Covered” means that all approved cancer treatment, drugs, and services will be paid for by the WTC Health Program. The WTC Health Program will only cover these costs when you have been certified by the WTC Program Administrator for a specific cancer. The list of WTC-related cancers are the only types of cancers that can be considered for certification. The WTC Program Administrator is certifying that your 9/11 exposure is related to your cancer.

How do I get my cancer certified?

If you are currently enrolled in the WTC Health Program:

Certification is a two-step process.
1. First, your WTC Health Program doctor must confirm that the type of cancer you have is one of the cancers on the List of WTC-Related Health Conditions. This means that the doctor will have to review your biopsy report and other medical records. The doctor must also find that exposure to airborne toxins, other hazards, or adverse conditions resulting from the September 11, 2001, terrorist attacks is substantially likely to be a significant factor in aggravating, contributing to, or causing your cancer. To do this the doctor must have the details of your WTC exposure and your subsequent medical history.

If your doctor confirms that you do have one of the cancers on the List of WTC-Related Health Conditions and that your exposure resulting from the September 11, 2001, terrorist attacks is substantially likely to be a significant factor in aggravating, contributing to, or causing your cancer, she or he will request certification of your cancer from the Administrator of the WTC Health Program.

2. The Administrator then reviews all doctors’ requests for cancer certification. Your cancer will be certified for treatment coverage unless the Administrator finds that your cancer is not a cancer on the List of WTC-Related Health Conditions or that your exposure resulting from the September 11, 2001, terrorist attacks is not substantially likely to be a significant factor in aggravating, contributing to, or causing your cancer.

If you are not a member of the World Trade Center Health Program:
Please visit our website for information about the application process, www.cdc.gov/wtc. You can also contact the WTC Health Program at 1-888-982-4748 for information on how to apply.

If I have one of the cancers on the list, am I automatically eligible for treatment coverage in the WTC Health Program?

No. The inclusion of your cancer on the List of WTC-Related Health Conditions does not mean that your cancer will automatically be covered by the Program. Your Program doctor must also find that your WTC-related exposures caused, aggravated, or contributed to your cancer and request certification of your cancer from the WTC Program Administrator. If the Administrator certifies your cancer, then you are eligible for treatment coverage in the WTC Health Program.

When can a WTC Health Program member begin the process of certification of their cancer?

The process of requesting certification for cancer may begin as of October 12, 2012. Members should contact their current Clinical Center of Excellence (CCE) to begin this process. If you do not know which CCE you are with, please contact our call center at 1-888-982-4748.

If you are not yet enrolled, and believe you may be eligible for the Program, please visit the WTC Health Program website for information about the application process, www.cdc.gov/wtc or contact the WTC Health Program at 1-888-982-4748.

How long does certification take?
It is not possible to provide a specific estimate for how long certification should take because each case is different. However, the WTC Program Administrator knows that certification decisions must be made as quickly as possible. Certification of a cancer and beginning treatment are two separate issues. Once your cancer has been certified by the WTC Program Administrator, you are eligible for treatment coverage for your cancer in the WTC Health Program. You and your doctor, however, must make decisions about when you should begin treatment based on your cancer and medical needs.

Will I be informed of the certification decision?

Yes. You will be notified by either your CCE or the WTC Program Administrator. The details of how you will be notified are still being finalized. If your cancer is denied certification, then you will receive information about your appeal rights with the denial letter.

If my cancer is not certified, do I have a right to appeal?

If you are denied certification, this means that your cancer treatment will not be paid for by the WTC Health Program. You have a right to appeal a denial. Information on how to appeal a denial will be included in the letter informing you of the WTC Program Administrator’s denial decision.

How soon after my cancer is certified will I actually expect to begin treatment?
Certification of a cancer and beginning treatment are two separate issues. Once your cancer has been certified by the WTC Program Administrator, you are eligible for treatment coverage for your cancer in the WTC Health Program. You and your doctor, however, must make decisions about when you should begin treatment based on your cancer and medical needs.

If I have cancer and I am already seeing a doctor for my cancer care, can I still keep seeing my doctor?

In order for a WTC Health Program member to obtain coverage for treatment of any health condition on the List of WTC-Related Health Conditions, including any type of cancer added to the List, the condition must first be certified by the WTC Program Administrator.

All care for the WTC Health Program must be rendered by a provider affiliated with the WTC Health Program. If your current provider is affiliated with the WTC Health Program, then you will be able to continue seeing your doctor. If your current provider is not affiliated, ask the provider to contact your CCE to discuss becoming a WTC Health Program provider.

Will the WTC Health Program provide reimbursements to individuals for cancer treatment costs incurred before October 12, 2012?

No. The WTC Health Program will not reimburse members or healthcare providers for the costs of cancer treatments received before October 12, 2012.

However, you might be able to receive compensation through the September 11th Victim Compensation Fund (VCF) for past cancer treatment costs. The VCF is administered by the Department of Justice, and enrollment in that program is separate from the WTC Health Program. For information regarding the VCF, please visit www.vcf.gov or call the VCF toll-free at 1-855-885-1555.

Does this mean that the Victim Compensation Fund (VCF) will be adding cancer to their list?

Yes. For information regarding the VCF, please visit www.vcf.gov or call the VCF toll-free at 1-855-885-1555.

When can the WTC Health Program begin to provide reimbursements to individuals for cancer treatment costs incurred after October 12, 2012?

Treatment costs can only be reimbursed for certified conditions, and for authorized services rendered by providers affiliated with the WTC Health Program. Once certified, costs can be reimbursed as of the date the condition is certified by the WTC Program Administrator. As of this time, a final decision has not been made whether to allow for any special authorizations to pay for treatment rendered before certification is finalized. As with any expansion of services, program specifics are still being decided and we will keep you informed of important changes as information becomes available.

If my cancer is certified by the WTC Health Program, are there any types of monetary caps or financial limits placed on the dollar amount of the care I’m entitled to?

No. There is no financial limit for the required treatment of your cancer if it has been certified by the WTC Program Administrator. However, the James Zadroga 9/11 Health and Compensation Act only provides funding for the WTC Health Program through 2016. At this time, we don’t know if additional funding will be made available for medical monitoring and treatment of cancer or any other illness on the List of WTC-Related Health Conditions after 2016.

What if my cancer is not on the List of WTC-Related Health Conditions?

Starting October 12, 2012, only those cancers on the List of WTC-Related Health Conditions will be covered by the program. Even if you think your cancer is not on the list, you should contact your CCE to inform your doctor about your cancer and find out if it is covered by the WTC Health Program.

If you find out that your cancer is not covered, this means that the WTC Health Program will not cover the costs of your cancer treatment, drugs, and services. However, if needed, your doctor will work with you to help you identify a place to get your care.

In addition, there is a process for adding additional types of cancer to the List of WTC-Related Health Conditions in the future. The Administrator may propose the addition of other types of cancer if he determines that there is evidence of a relationship between WTC exposures and a specific type of cancer. If your cancer is added to the List of WTC-Related Health Conditions in the future, the WTC Health Program will make every effort to inform you of this change.

What was the process for adding these types of cancers to the List of WTC-Related Health Conditions?

In September 2011, the Administrator received a petition that requested he consider adding coverage for cancer(s) to the WTC Health Program. As permitted by the Act, the Administrator consulted with the WTC Health Program Scientific/Technical Advisory Committee (STAC). After receiving the STAC’s recommendation, the Administrator issued a notice of proposed rulemaking on June 13, 2012, proposing to add certain types of cancer to the List of WTC-Related Health Conditions. The Administrator received comments from the public offering both support and criticism of the proposal. The public comments were addressed in the final rule, which was published in the Federal Register on September 12, 2012.

In the September 12, 2012 final rule, the WTC Program Administrator announced the addition of all of the types of cancer that were included in the June 2012 Notice of Proposed Rulemaking. The final rule will become effective on October 12, 2012. At that time, WTC Health Program members who have one of the covered cancers are encouraged to contact their CCE to begin the process of determining if their cancers qualify to be certified by the Administrator as WTC-related health conditions.

When will the WTC Program Administrator be considering whether or not to add other types of cancer?

The Administrator may propose the addition of a type of cancer if he determines that there is evidence of a relationship between WTC exposures and a specific type of cancer.

I have cancer now. What should I do?

If you are a member of the World Trade Center Health Program:
Contact your Clinical Center of Excellence (CCE) to schedule an appointment so that you can begin the cancer certification process as soon as possible. If you do not know which CCE you are with, please contact our call center at 1-888-982-4748.

In addition, you may be able to receive compensation through the September 11th Victim Compensation Fund (VCF) for cancer treatment costs and economic loss you have experienced due to cancer. The VCF is administered by the Department of Justice, and enrollment in that program is conducted separately from the WTC Health Program. For information regarding the VCF, please visit www.vcf.gov or call toll-free: 1-855-885-1555.

If you are not a member of the World Trade Center Health Program:
Please visit our website for information about the application process, www.cdc.gov/wtc. You can also contact the WTC Health Program at 1-888-982-4748 for information on how to apply.

I don’t have cancer now, but I have had cancer since September 11, 2001. What should I do?

If you are a member of the World Trade Center Health Program:
Contact your Clinical Center of Excellence (CCE) to schedule an appointment to review your medical history. Your doctor will determine if the cancer certification process should be started in case you need treatment again in the future. If you do not know which CCE you are with, please contact our call center at 1-888-982-4748.

If you are not a member of the World Trade Center Health Program:
Please visit our website for information about the application process, www.cdc.gov/wtc. You can also contact the WTC Health Program at 1-888-982-4748 for information on how to apply.

In addition, you may be able to receive compensation through the September 11th Victim Compensation Fund (VCF) for prior cancer treatment costs and economic loss you’ve experienced due to cancer. The VCF is administered by the Department of Justice, and enrollment in that program is conducted separately from the WTC Health Program. For information regarding the VCF, please visit www.vcf.gov or call toll-free: 1-855-885-1555.

I don’t have cancer now, but what if I get it in the future? What should I do then?

If you are a member of the WTC Health Program, it is important that you continue to go to your annual monitoring exams so that your health can be checked. If a doctor finds that you have cancer or any other WTC-related health condition during your annual monitoring exam, the doctor would complete a determination and request certification of those conditions as soon as possible so that you could get the treatment you need.

At any point in time, if you find out you have cancer, contact your CCE as soon as possible so that your doctor can determine if the certification process should be started. If you do not know which CCE you are with, please contact our call center at 1-888-982-4748.

What if I want to be screened for cancer?

Screening for breast or colon cancer may be available in the future as part of the annual monitoring exam benefit using the U.S. Preventive Services Task Force guidelines. Although screening does not require a member to have a certified condition, other requirements, such as age, may have to be met. Screening mammograms and colonoscopies will not begin until the WTC Program Administrator further defines these screening eligibility requirements.

What should I do if I am not a member of the WTC Health Program?

If you believe you may be eligible for the Program, please visit the WTC Health Program website for information about the application process, www.cdc.gov/wtc or contact the WTC Health Program at 1-888-982-4748.

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