WTC Health Program: Program Overview October 18, 2014 Laurie Breyer, JD, MA, Director Member Services Gayatri Martin MD, MPH, Medical Officer Pentagon photo courtesy of FEMA. Shanksville photo by vlashton, courtesy of Flickr.
What is the World Trade Center (WTC) Health Program? • The World Trade Center (WTC) Health Program provides health screenings and treatment for those who were directly affected by the September 11th terrorist attacks in New York City, the Pentagon, and in Shanksville, PA. • The WTC Health Program continues the monitoring and treatment programs in the NYC area prior to the passage of the James Zadroga 9/11 Health and Compensation Act of 2010. This includes the Medical Monitoring and Treatment Program (MMTP), the WTC Environmental Health Center (EHC) Community Program, and FDNY. • Care is provided through 7 Clinical Centers of Excellence in New York City/New Jersey or through the Nationwide Provider Network , which matches members outside of the New York metropolitan area with medical providers near where they live. The Program is administered by the National Institute for Occupational Safety and • Health (NIOSH), an Institute within the Centers for Disease Control and Prevention (CDC).
WTC Health Program Eligibility The Program serves Responders who worked at the World Trade Center or • related sites, the Pentagon, or in Shanskville, PA. Responders include * : – Members of a fire or police department (active or retired) – Emergency health workers – Workers from recovery or cleanup contractors – Volunteers who assisted in rescue, recovery, or clean up efforts • The Program also provides benefits for New York City Survivors who were present in the dust cloud on 9/11 or who lived, worked, went to school, or adult daycare in the NYC Disaster Area. * For a full list of eligibility criteria and categories go to www.cdc.gov/wtc
WTC Health Program Enrollment (as of 9/8/2014) Enrollment Category Grandfathered New Enrollees Total Enrollment (61,107) (7,787) (68,894) General Responder 34,204 3,786 37,990 (55%) CCEs: Survivors (including 4,735 2,681 7,416 (11%) Reenrolls): FDNY: 16,564 22 16,586 (24%) NPN (including 5,595 1,567 7,162(10%) Responders and Survivors): Pentagon and Shanksville Enrolled as of 9/8/2014*: Pentagon 243 Shanksville 14 * All outside of the NYC Metropolitan Area
Program Benefits The Program provides annual health screenings for responders and for • certified-eligbile survivors that evaluate many aspects of a member’s physical and mental health. The Program provides medical care for conditions certified to be caused, • contributed to, and/or aggravated by the September 11 th terrorist attacks. – Medical tests – Doctor visits – Surgery – Prescription drugs • There are no out-of-pocket costs for members
How is a condition covered by the Program? • In order for a condition to be covered it must be “certified” by the WTC Health Program Administrator It is 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 experience in treating or diagnosing the health conditions included in the applicable 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
What conditions are covered by the Program? Airway and Digestive Disorders • – Interstitial lung diseases (diseases that cause scarring of lung tissue) – Chronic respiratory disorder-fumes/vapors – Asthma – Reactive airways dysfunction syndrome (RADS) – WTC-exacerbated chronic obstructive pulmonary disease (COPD) – Chronic cough syndrome – Upper airway hyperreactivity – Chronic rhinosinusitis – Chronic nasopharyngitis – Chronic laryngitis – Gastroesophageal reflux disorder (GERD) – Sleep apnea exacerbated by or related to any of the above conditions
What conditions are covered by the Program? • Mental Health Conditions – Posttraumatic stress disorder (PTSD) – Major depressive disorder – Panic disorder – Generalized anxiety disorder – Anxiety disorder (not otherwise specified) – Depression (not otherwise specified) – Acute stress disorder – Dysthymic disorder – Adjustment disorder – Substance abuse
What conditions are covered by the Program? • Musculoskeletal disorders for those WTC responders who received any treatment for a WTC-related musculoskeletal disorder on or before September 11, 2003: – Low back pain – Carpal tunnel syndrome [CTS] – Other musculoskeletal disorders • Other Conditions related to disease progression or complication from treatment of the above covered health conditions known as Medically Associated Conditions(MACs)
What conditions are covered by the Program? • 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
What conditions are covered by the Program? • Mesothelioma • Childhood cancers (any type of cancer diagnosed in a person less than 20 years of age) • Rare cancers any type of cancer that has an incidence rate of less than 15 cases per 100,000 persons per year in the United States based on 2005- 2009 average annual data age-adjusted to the 2000 U.S. population.
Top 10 WTC-3 Certified Conditions (as of 9/3/2014) Condition Category Number of Members with Condition GERD 3,405 Chronic Rhinitis 2,353 Unspecified Sinusitis 2,290 Asthma 1,598 Adjustment Reaction 1,505 Non-melanoma Skin 586 Prostate Cancer 573 Anxiety 463 Episodic Mood - Depression 353 Melanoma of Skin 224
Top 15 Certified Cancer Conditions (as of 9/3/2014) Type of Cancer Instances Non-melanoma Skin 586 Prostate 573 Melanoma of Skin 224 Non-Hodgkin’s Lymphoma 219 Thyroid 190 Lung/Bronchus 143 Kidney 138 Breast 135 Leukemia 132 Colon 131 Bladder 111 Multiple Myeloma 67 Oropharynx 47 Stomach 36 Rectum 31
Medical Team Tasks and Responsibilities • Perform Certification Reviews Perform Victims Compensation Fund (VCF) Verification Reviews • – The September 11th Victim Compensation Fund (VCF) is designed to provide compensation for economic and non-economic loss for individuals who were physically injured 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. – Federally-funded Program administered by the Department of Justice – Originally established in 2001 by Congress in an effort to bring financial relief to those most devastated by the events of September 11, 2001 – The original Fund is often referred to as “VCF1”, “the first Fund”, or “original VCF”
Medical Team Tasks and Responsibilities • Make Decisions regarding Medical Benefits, Services and Claims • Provide Subject Matter Expertise regarding Special Member Cases • Develop Policies and Procedures for the WTC Health Program Perform Utilization Review for Fraud, Waste and Abuse • • Miscellaneous Tasks as Needed
Considerations • CDC defines "policy" as a law, regulation, procedure, administrative action, incentive, or voluntary practice of governments and other institutions. – Must adhere to the James Zadroga 9/11 Health and Compensation Act of 2010 and it regulations and any resulting policies and procedures when making program decisions. • The Zadroga Act and its regulations can be found at www.cdc.gov/wtc/regulations.html – Must adhere to other established program policies located at www.cdc.gov/wtc/policies.html
Considerations • Fairness, consistency and transparency • National Clinical standards of care and practices(consensus guidelines, expert opinion, medical evidence base) as well as locally acceptable healthcare practices Benchmarking with other similar government programs and insurance • entities • Fiscal responsibility • Appropriate documentation • Coordination with various parts of the WTC Health Program - requires effective communication • Establishing QA standards for evaluation and continuous improvement
Challenges • Things to consider when performing program tasks and responsibilities pose challenges due to: – Conflicting medical evidence or recommendations – Competing priorities – Need to document policy decisions for a new and changing Program • Transforming concepts/ideas into detailed policies and procedures is challenging: – When drawing lines based upon lack of sufficient information – When many aspects of the program are in constant flux due to issues that arise from early phases of program implementation and development
Recommend
More recommend
