World Trade Center 9/11 Health Monitoring and Treatment Program
United States House of Representatives Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies
Wednesday, March 12, 2008
John Howard, M.D., M.P.H.
National Institute for Occupational Safety and Health
Centers for Disease Control and Prevention
U.S. Department of Health and Human Services
The Department of Health and Human Services (HHS) appreciates the opportunity to report on the progress made in addressing the health needs of those who served in the response effort after the World Trade Center (WTC) attack on 9/11 and to discuss our future plans for the WTC Medical Monitoring and Treatment Program.
Since 2002, agencies and offices within HHS have been dedicated to tracking and screening WTC rescue, recovery and clean up workers and volunteers (responders). In 2003, Congress directed $90 million appropriated to FEMA as part of the Emergency Response Fund to be reserved for clinical reexaminations and long term health monitoring and analysis for emergency services personnel and rescue and recovery personnel. In FY 2006, Congress appropriated $75 million to the Centers for Disease Control and Prevention (CDC) to further support existing HHS WTC programs that provide screening, monitoring, and medical treatment for responders. These funds enabled CDC to establish the WTC Medical Monitoring and Treatment Program managed by the National Institute for Occupational Safety and Health (NIOSH) at CDC.
In FY 2007, in the U.S. Troop Readiness, Veterans Health, Katrina Relief and Iraq Accountability Appropriations Act, 2007, Congress appropriated an additional $50 million to CDC for screening, monitoring, and medical treatment for responders. The Consolidated Appropriations Act of 2008 appropriated $108 million to provide screening and treatment for first response emergency services personnel, residents, students, and others related to the September 11, 2001 terrorist attacks on the World Trade Center. To date, $50 million of the FY 2007 and $108 million of the FY 2008 funds remain unexpended. Of the funds appropriated in FY 2003 and FY 2006, $25.8 million and $37.7 million respectively, remain available. Currently, a total of $221.5 million remain available for WTC medical monitoring and treatment services.
PROGRAM ACTIVITIES FOR RESPONDERS
The WTC Medical Monitoring and Treatment Program consists of six clinical centers and two data and coordination centers in the New York-New Jersey metropolitan area that currently receive federal funding to provide voluntary health screening, monitoring, and treatment, as directed by Congress in the FY 2006 Appropriations bill. These clinical centers and data and coordination centers provide patient tracking, standardized clinical and mental health screening, treatment services, and patient data management. As of December 31, 2007, 50,300 responders have enrolled in the WTC Medical Monitoring and Treatment Program, and more than 39,500 responders have had an initial medical screening via the New York City Fire Department (FDNY), the Mt. Sinai clinical consortium, or a national network of clinics outside the NYC-NJ metropolitan area.
The New York City Fire Department (FDNY) manages the clinical center that serves the 16,000 FDNY firefighters and emergency medical service personnel enrolled in the Program. As of December 31, 2007, FDNY has conducted over 32,000 screenings, including 14,620 initial examinations and 17,569 follow-up examinations.
The Mt. Sinai School of Medicines Center for Occupational and Environmental Medicine coordinates a consortium of clinics that serve other response workers and volunteers who were active in the WTC rescue and recovery efforts. As of December 31, 2007, these clinics have conducted 22,748 initial examinations and 11,315 follow up examinations.
Of the 37,368 responders in the WTC Medical Monitoring and Treatment Program that have received an initial screening via a clinical center in the New York City-New Jersey metropolitan area, 9,744 have received treatment for aerodigestive conditions, such as asthma, interstitial lung disease, chronic cough, and gastro-esophageal reflux, and 5,674 have been treated for mental health conditions. The availability of treatment for both physical and mental WTC-related health conditions has encouraged more responders to enroll and continue participating in the WTC Medical Monitoring and Treatment Program, which will enable us to better understand and help treat the long-term effects of their WTC exposures. To ensure the availability of monitoring and treatment services for responders in the NYC-NJ metropolitan area, CDC/NIOSH will continue to support the existing clinical centers through the conclusion of their grant award, which expires June 1, 2009. CDC will be issuing a competitively-bid contract request for proposals to continue uninterrupted medical monitoring and treatment services for responders in the NYC-NJ metropolitan area prior to June 2009.
Many rescue and recovery workers traveled from other states to New York City to participate in the response efforts and following their service, they returned to their states of origin. It is estimated that between 5,000 to 10,000 WTC responders currently reside outside of the New York-New Jersey metropolitan area⊃1;. As of December 31, 2007, 3,300 responders residing outside the NYC-NJ metropolitan area have enrolled in the WTC Monitoring and Treatment Program. These responders, including current and former Federal employees, receive monitoring services via a national network of clinics managed by QTC, Inc through a contract managed by the Mt. Sinai School of Medicine. The American Red Cross (ARC) has been generously providing further diagnostic and treatment services when responders are referred to medical providers by QTC, Inc. As a result of the ARC support, the treatment of responders who elect not to travel to the NYC-NJ metropolitan area for services have not required support with Federal funds. CDC is preparing to issue a request for contracts to assure that medical monitoring and treatment services provided to responders outside the NYC-NJ metropolitan area are uninterrupted, given the expected expiration of ARC funding before June 2008. CDC will issue a one-year contract aligned with the current NYC-NJ institutional program grants.
These contracts, for medical monitoring and treatment services within and outside of the NYC-NJ metropolitan area, will draw upon the remaining balance of the $221.5 million currently appropriated and the Presidents FY 2009 budget request of $25 million. Six quarters of demographic and financial information from the grantees indicates that with the Presidents FY 2009 budget request, CDC/NIOSH has the appropriate resources necessary to support ongoing medical monitoring and treatment for responders through FY 2009. We will continue to monitor activities on a quarterly basis and work with Congress as new information becomes available.
From September 11, 2001 to present, the WTC Monitoring and Treatment Program has provided services specifically to WTC responders. In the Consolidated Appropriations Act of 2008, Congress appropriated funding ” to provide screening and treatment for first response emergency services personnel, residents, students, and others”. CDC/NIOSH are beginning to meet with community stakeholder groups and potential providers in the NYC-NJ metropolitan area to gather the data and information needed to inform these considerations.
EARLIER REQUEST FOR CONTRACTS
In October 2007, CDC/NIOSH published a Request for Proposal (RFP) for a WTC Business Processing Center (BPC) and held a pre-proposal conference in New York City. The intent of the WTC BPC solicitation was to secure the services of an experienced third party health care payer to coordinate claims processing and bill payment for monitoring and treatment services provided by the WTC Responder Health Program, provide a nationwide pharmacy benefit plan for program enrollees, and establish and manage a national network of health care providers to provide monitoring and treatment to responders outside of the NY-NJ metropolitan area. The BPC was intended to improve upon issues of accessibility and reporting of demographic, clinical and financial data.
On December 13, 2007, CDC/NIOSH cancelled the RFP (2007-N-09656). The primary reason for the cancellation was as follows: (1) It was not clear that funding was available to support the Performance Work Statement (PWS); (2) The Technical Requirements in the PWS required clarification; (3) The interest from industry had been limited attendance at a pre-proposal conference was unusually small for a procurement of this size and questions related to the RFP raised a number of technical and programmatic issues. In addition, the existing grants had eighteen months to continue to provide medical monitoring and treatment services to the responders until they expire on June 1, 2009. Again, CDC/NIOSH will also be taking steps to ensure the uninterrupted continuation of medical monitoring and treatment services for responders after June, 2009.
CURRENT CHALLENGES AND FUTURE PLANS
Predicting funding needs remain a challenge. CDC/NIOSH continues to work closely with the grantees to collect data on spending rates and funding needs to ensure continuity in services to responders. Many of the existing grantees were recipients of ARC funding, as previously mentioned, and have not relied solely on federal resources. As of the fourth quarter of FY 2007, the grantees have exhausted the majority of ARC funding; thus, the two most recent quarters provide critical insight to the current federal funding needs. In the last two quarters, covering July 1 through December 31, 2007 grantees spent a total of $19.8 million to provide both medical monitoring and treatment to responders, of which $14.2 million is for treatment. CDC/NIOSH will continue to gather financial data from the grantees in order to better understand the costs associated with the healthcare needs of the responders.
HHS/CDC/NIOSH remain committed to serving all emergency responders, regardless of their location or current employment status, and are actively working together to ensure that coordinated monitoring and treatment services remain available to responders affected by WTC exposures utilizing the most cost effective means possible. The Presidents FY2009 Budget requests $25 million for this effort. We are dedicated to improving the effectiveness of the WTC Monitoring and Treatment program, which is enhanced by timely quarterly data provided by the grantees. As requested, we will provide a report to Congress on April 27, 2008.
Thank you for this opportunity to provide you with information on our progress to improve and expand the WTC Monitoring and Treatment Program.
⊃1;This range is based on an estimate of the number of Federal responder used in the development of an Interagency Agreement between FEMA and HHS/ASPR for providing services for Federal responders across the country.