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), Centers for Disease Control and Prevention (CDC), 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:
To be associated with or belong to.
Appeal:
To challenge a decision made by the Administrator to not cover a condition or a particular procedure.
Appeal Coordinator:
The Program staff person who manages all the parts of the appeal process, including helping you to schedule an oral statement if requested, sending you letters about the status of your appeal, and answering your questions about what you need to do to file an appeal.
Authorization:
To give permission for a service to be covered under the Program.
Authorized:
Approved for coverage by the Program.
Benefits Counseling:
A service available to members where a 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 Program that your health condition is included on the List of WTC-Related Health Conditions and that your 9/11 exposures are sufficiently related your health condition such that your health condition is eligible for treatment by the Program.
Certified:
A certified WTC-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 WTC Survivor with a certified WTC-related health condition(s). These individuals are eligible for yearly follow-up exams and treatment for certified WTC-related and medically associated health condition(s).
Clinical Center of Excellence (CCE):
A center or centers under contract with the Program that provides health services to members.
Colonoscopy:
A medical exam to see if there are any changes or anything abnormal in your large intestine (colon) and rectum. A long, flexible tube with a video camera at the end is put into your rectum so that the doctor can see all of your colon.
Designated Representative:
A person that you choose to represent your interests in the Program. This person can represent your interests during an appeal process.
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.
Extended Care Services:
Medical or rehabilitation services provided to a member in a longterm care facility, such as a skilled nursing facility or rehabilitation program.
Federally Qualified Health Center:
Community-based organizations that provide medical, dental, and mental health/substance abuse services to persons of all ages, regardless of their ability to pay or health insurance status.
First Payer:
When you have more than one source of payment for your medical services, the source that pays for those services before all other sources pay anything.
Formulary:
A list of prescription drugs covered by the Program.
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.
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 who is dying of 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:
Assessment of one or more symptoms that may be associated with a WTC-related health condition and includes a medical and exposure history, a physical examination, and additional medical testing as needed to evaluate whether the individual has a WTC-related health condition and is eligible for treatment under the Program.
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:
Public Law 111-347 passed by the United States Congress in 2010 that created the WTC Health Program. The law provided funding for medical screening and monitoring, medical and mental health treatment, and benefits counseling for WTC responders and survivors. The Act also reopened the September 11th Victim Compensation Fund.
Last Payer:
When you have more than one source of payment for your medical services, the source that pays for those services after all other sources pay for the care.
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 Authorization:
When your WTC Health Program provider must request permission from your CCE Medical Director (or the NPN Medical Director) for your needed treatment or medical services to be covered by the Program.
Level 3 Authorization:
When your WTC Health Program provider must request permission from the Program’s Medical Benefits Team at NIOSH 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 and coordinates Program health care for members who live outside of the NY Metropolitan Area and want to receive their 9/11 health care services locally.
Mammogram:
An X-ray of the breast.
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).
Medical Monitoring Exam/Annual Monitoring Exam:
Detailed yearly health exam of a WTC responder or certified-eligible survivor that looks for 9/11-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.
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:
The provision of 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, ameliorate, or cure a certified WTC-related health condition or a health condition medically associated with a WTC-related health condition, and which conforms to Program medical treatment protocols.
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.
National Comprehensive Cancer Network (NCCN):
A not-for-profit alliance of 23 of the world’s leading cancer centers dedicated to improving the quality and effectiveness of care provided to patients with cancer. NCCN develops guidelines for treating various types of cancer.
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 9/11 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.
Petition:
A formal written request to the Administrator to add a health condition to the List of WTC-Related Health Conditions.
Screening-Eligible Survivor:
An individual who is not a WTC Responder, has symptoms of a WTC-related health condition, and meets the Program’s current eligibility criteria. 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 of September 11, 2001, or debris removal efforts that took place in the immediate aftermath of the attacks.
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 does require professional attention within 24 hours.
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 to the September 11, 2001, terrorist attacks and initial health evaluation, monitoring, and treatment benefits for residents, building occupants, area workers, and others in New York City who were directly impacted and adversely affected by such attacks.
World Trade Center (WTC)-related acute traumatic injury:
Physical damage to the body caused by and occurring immediately after a one-time exposure to energy, such as heat, electricity, or impact from a crash or fall, resulting from a specific event or incident. To be certified by the Program, a WTC Responder or Screening-Eligible or Certified-Eligible Survivor must have received medical treatment for the WTC-related acute traumatic injury on or before September 11, 2003.
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.
A chronic or recurrent disorder of the musculoskeletal system caused by heavy lifting or repetitive strain on the joints or musculoskeletal system occurring during rescue or recovery efforts in the New York City disaster area in the aftermath of the September 11, 2001, terrorist attacks.
WTC Health Registry:
A study to document and evaluate the long-term physical and mental health effects of 9/11.
WTC Program Administrator (the Administrator):
The Director of the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Department of Health and Human Services, or his or her designee. The Administrator is the person responsible for overseeing and administering the Program.
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, terrorist attacks, based on an examination by a medical professional with expertise in treating or diagnosing the health conditions in the list of conditions, is substantially likely to be a significant factor in aggravating, contributing to, or causing the illness or health condition or a mental health condition. A WTC-related health condition includes conditions on the list of WTC-related health conditions.
WTC Responder:
There are three groups of responders (also referred to as rescue, recovery, debris clean-up, and support services workers and volunteers) who might be eligible for the WTC Health Program. These groups are:
  • FDNY Responders and Family Members
  • NYC, or "General" Responders (including NYPD)
  • Pentagon and Shanksville, PA Responders
For more detailed eligibility information for WTC responders, refer to the Program's
website at www.cdc.gov/wtc/eligiblegroups.html
WTC Survivor:
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 daycare in lower Manhattan south of Houston Street and parts of Brooklyn for certain amounts oftime 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. For more detailed eligibility information for WTC Survivors, refer to the Program’s website at www.cdc.gov/wtc/eligiblegroups.html