Comparison of the Current World Trade
Center Medical Monitoring and Treatment
Program and the World Trade Center Health
Program Proposed by Title I of H.R. 847
Scott Szymendera
Analyst in Disability Policy
Sarah A. Lister
Specialist in Public Health and Epidemiology
September 2, 2010
Congressional Research Service
7-5700
www.crs.gov
R41292
CRS Report for Congress
P
repared for Members and Committees of Congress
Comparison of the WTC MMTP and the WTCHP Proposed by Title I of H.R. 847
Summary
In the wake of the September 11, 2001, terrorist attack on New York City, Congress passed
appropriations to provide limited health screening and treatment services to persons involved in
rescue, recovery, and cleanup operations around the former site of the World Trade Center. This
program, now known as the World Trade Center (WTC) Medical Monitoring and Treatment
Program (MMTP), is not authorized in statute but rather relies on discretionary appropriations to
provide services to eligible individuals. Since its inception in FY2002, the MMTP has received
approximately $475 million in federal funds, and over 57,000 responders and community
members have met initial eligibility requirements for the program.
Title I of H.R. 847 would eliminate the current MMTP and replace it with a program authorized
in statute and financed through mandatory federal spending, partially matched by New York City.
This program, proposed to be called the World Trade Center Health Program (WTCHP), would
provide full medical screening and treatment benefits to eligible WTC responders and community
members. In addition, Title I of H.R. 847 would establish formal eligibility requirements based on
a person’s activities after September 11, 2001, and his or her current health conditions. Health
benefits would be provided by a national network of providers, and the program would be
administered by the Department of Health and Human Services (HHS).
The proposed WTCHP would sunset at the end of FY2020, and total federal spending on the
program would be capped at $4.6 billion over the life of the program. New York City would
contribute 10% of the program’s costs, up to a program-life cap of $511 million. In addition to
persons already receiving services under the MMTP, the WTCHP would serve up to 25,000 new
responders and 25,000 new community members.
On July 29, 2010, an amendment in the nature of a substitute to H.R. 847 was considered by the
House of Representatives under suspension of the rules and failed to gain the necessary two-
thirds majority for passage. The Senate version of the bill, S. 1334, was referred to the Senate
Committee on Health, Education, Labor, and Pensions and has not been reported.
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Comparison of the WTC MMTP and the WTCHP Proposed by Title I of H.R. 847
Contents
Brief Descriptions of Programs ................................................................................................... 1
World Trade Center Medical Monitoring and Treatment Program .......................................... 1
World Trade Center Health Program...................................................................................... 2
Comparison of Program Elements ............................................................................................... 3
Authority .............................................................................................................................. 3
Current MMTP ............................................................................................................... 3
Proposed WTCHP........................................................................................................... 3
Financing.............................................................................................................................. 3
Current MMTP ............................................................................................................... 3
Proposed WTCHP........................................................................................................... 3
Eligibility for Benefits........................................................................................................... 4
Current MMTP ............................................................................................................... 4
Proposed WTCHP........................................................................................................... 5
Covered Conditions .............................................................................................................. 7
Current MMTP ............................................................................................................... 7
Proposed WTCHP........................................................................................................... 8
Benefits ................................................................................................................................ 9
Current MMTP ............................................................................................................... 9
Proposed WTCHP........................................................................................................... 9
Provision of Medical Services ............................................................................................... 9
Current MMTP ............................................................................................................... 9
Proposed WTCHP......................................................................................................... 10
Tables
Table 1. Responders and Community Members Meeting Initial Eligibility Requirements
of the WTC Medical Monitoring and Treatment Program (MMTP) .......................................... 2
Table 2. Covered Conditions for Eligible Responders Under the WTC Medical
Monitoring and Treatment Program (MMTP)........................................................................... 8
Table A-1. Funding for the WTC Medical Monitoring and Treatment Program .......................... 11
Table A-2. Maximum Contributions to the Proposed World Trade Center Health Fund.............. 11
Appendixes
Appendix. Funding Data for the WTC Medical Monitoring and Treatment Program
(MMTP) and the Proposed World Trade Center Health Fund .................................................. 11
Contacts
Author Contact Information ...................................................................................................... 11
Congressional Research Service
Comparison of the WTC MMTP and the WTCHP Proposed by Title I of H.R. 847
Brief Descriptions of Programs
This report compares the current federally supported medical screening and treatment program
offered to various persons affected by the terrorist attack on New York City on September 11,
2001, with the federal program proposed to be established by Title I of H.R. 847, the James
Zadroga 9/11 Health and Compensation Act of 2010, as amended. The following specific
programs are compared in this report:
• The World Trade Center (WTC) Medical Monitoring and Treatment Program
(MMTP), financed through discretionary appropriations to the Centers for
Disease Control and Prevention (CDC), National Institute for Occupational
Safety and Health (NIOSH);1 and
• The World Trade Center Health Program (WTCHP) proposed by Title I of H.R.
847, reported by the House Committee on Energy and Commerce on July 22,
2010.2
Related programs such as the World Trade Center Health Registry, administered by the CDC
Agency for Toxic Substances and Disease Registry (ATSDR), and the September 11th Victim
Compensation Fund of 2001 are not discussed in this report.3 This report does not discuss the
provisions of the Senate version of this bill, S. 1334, which was referred to the Senate Committee
on Health, Education, Labor, and Pensions and has not been reported.
World Trade Center Medical Monitoring and Treatment Program
Following the September 11, 2001, terrorist attack on New York City, Congress provided
appropriations to provide health care services for rescue, recovery, and cleanup workers and
others, in what is now called the World Trade Center (WTC) Medical Monitoring and Treatment
Program (MMTP).4 The MMTP is not explicitly authorized, but has received discretionary
1 Information about this program is summarized in CRS Report RL33927, Selected Federal Compensation Programs
for Physical Injury or Death, coordinated by Sarah A. Lister and C. Stephen Redheadhttp://apps.crs.gov/products/rl/
html/RL33927.html.
2 This version of H.R. 847 was introduced by Representative Henry Waxman on May 25, 2010 in the House Committee
on Energy and Commerce as an amendment in the nature of a substitute to the version of H.R. 847 forwarded to the full
committee by the Subcommittee on Health on March 16, 2010. During the committee mark-up, this amendment in the
nature of a substitute was further amended by amendments introduced by Representatives Anthony Weiner and Elliot
Engel, Representative Cliff Stearns, and Representative Michael Burgess. A copy of the amendment in the nature of
substitute can be found on the website of the House Committee on Energy and Commerce at
http://energycommerce.house.gov/Press_111/20100316/HR847.AINS.pdf. Copies of all amendments voted on during
the committee mark-up can be found on the website of the committee at http://energycommerce.house.gov/index.php?
option=com_content&view=article&id=2025:full-committee-markup-of-hr-847-the-james-zadroga-911-health-and-
compensation-act-of-201&catid=141:full-committee&Itemid=85.
3 Additional information on the World Trade Center Health Registry can be found at http://nyc.gov/html/doh/wtc/html/
registry/registry.shtml. Additional information on the September 11th Victim Compensation Fund of 2001 can be found
in CRS Report RL33927, Selected Federal Compensation Programs for Physical Injury or Death, coordinated by
Sarah A. Lister and C. Stephen Redhead.
4 The MMTP is one of a number of federal, state, and local programs that have funded or provided certain health care
services to various groups affected by the WTC disaster. Information about some other programs may be found in
GAO, September 11: Problems Remain in Planning for and Providing Health Screening and Monitoring Services for
Responders, GAO-07-1253T, September 20, 2007, p. 7 ff. Additional information on the MMTP can be found in CRS
Report RL33927, Selected Federal Compensation Programs for Physical Injury or Death, coordinated by Sarah A.
(continued...)
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Comparison of the WTC MMTP and the WTCHP Proposed by Title I of H.R. 847
appropriations to pay for medical monitoring and health care services for eligible individuals. The
MMTP funds medical screening, monitoring, and treatment services for eligible paid workers and
volunteers who were involved in the rescue, recovery, and cleanup activities following the attack
(referred to as “responders”), and more limited services for some residents and others in the
vicinity of the WTC during and after the attack (referred to as “community members”). Services
are provided through a limited network of providers.
As shown in Table 1, through the end of calendar year 2009, a total of 52,857 responders and
4,405 community members applied for and met the initial eligibility requirements for the MMTP.
Table 1. Responders and Community Members Meeting Initial Eligibility
Requirements of the WTC Medical Monitoring and Treatment Program (MMTP)
through December 31, 2009
Category
Met Initial Eligibility Requirements
Fire Department (FDNY) responders
15,721
Responders living in New York City area
32,924
Responders living outside of New York City area
4,212
Total all responders
52,857
Community members
4,405
Total 57,262
Source: Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
Number of Participants in the WTC Health Programs, http://www.cdc.gov/niosh/topics/wtc/participants.html.
Note: Includes all persons who have met the initial eligibility requirements of the program, whether or not they
have received any program benefits.
World Trade Center Health Program
Title I of H.R. 847 proposes to establish the World Trade Center Health Program (WTCHP). The
WTCHP, unlike the MMTP, provides for the program’s entitlement authority and financing
through mandatory annual appropriations through FY2020. The WTCHP would provide medical
monitoring and treatment services to WTC responders and community members (referred to as
“survivors”) who meet statutory eligibility requirements. Services would be provided through
clinical centers of excellence in the New York area and a national network of approved providers.
On July 29, 2010, an amendment in the nature of a substitute to H.R. 847 was considered by the
House of Representatives under suspension of the rules and failed to gain the necessary two-
thirds majority for passage.5
(...continued)
Lister and C. Stephen Redhead.
5 A copy of the amendment in the nature of a substitute to H.R. 847 considered by the House of Representatives under
suspension of the rules on July 29, 2010 can be found at “James Zadroga 9/11 Health and Compensation Act of 2010,”
Congressional Record, daily edition, vol. 156 (July 29, 2010), pp. H6382-H6394.
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Comparison of Program Elements
Authority
Current MMTP
The current MMTP is not authorized in statute. Rather, the program’s authority comes from
discretionary appropriations to the Department of Health and Human Services (HHS), Centers for
Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health
(NIOSH). The FY2010 appropriation for this program was $70.273 million.6 The President has
requested $150.137 million for this program in his FY2011 budget request.7
Proposed WTCHP
The WTCHP proposed by Title I of H.R. 847 would be authorized as Title XXXI of the Public
Health Service Act.8 The Secretary of Health and Human Services would be authorized to appoint
one or more persons to serve as administrators of the WTCHP and carry out the enrollment,
payment, and secondary payer functions of the program. The bill does not specify which HHS
entity would be responsible for program management.
Financing
Current MMTP
The current MMTP is financed through discretionary appropriations to the CDC. Following the
September 11, 2001, terrorist attacks, Congress appropriated funds to the Federal Emergency
Management Agency (FEMA) for various response and recovery activities. FEMA entered into
agreements with NIOSH and other CDC centers to establish and carry out medical monitoring
programs for WTC responders and others. Appropriations were provided directly to CDC
thereafter. In FY2006, Congress authorized the use of appropriated funds for treatment services,
in addition to screening and monitoring. Table A-1, in the Appendix, provides a funding history
for the MMTP. In total, the program has received approximately $475 million since its inception.
Proposed WTCHP
Benefits and administrative costs under the WTCHP proposed by Title I of H.R. 847 would be
paid out of the World Trade Center Health Fund (the Fund) to be established by the legislation.
The Fund would be authorized from the last quarter of FY2011 through FY2020, and would be
financed by capped mandatory federal spending and contributions from New York City. The
federal spending cap would equal the lesser of 90% of actual program spending or annual
6 Consolidated Appropriations Act, 2010, P.L. 111-117.
7 Department of Health and Human Services, Centers for Disease Control and Prevention, Justification of Estimates for
Appropriation Committees, FY2011, Washington, DC, February 2010, pp. 231 and 235.
8 The Public Health Service Act is codified at 42 U.S.C. § 201 et. seq.
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spending limits provided in the legislation and described in Table A-2, in the Appendix.
Authorization of federal appropriations into the Fund would sunset after FY2020. H.R. 847 also
stipulates maximum amounts that may be spent each year on certain specified program activities.
New York City would be required to enter into a contract with the WTCHP to pay its required
share of program costs, and no money could be released from the Fund unless New York City has
entered into such a contract. New York City would be charged interest, in a manner specified in
the legislation, if it fails to make its contributions to the Fund on time. Provided New York City is
making its required contributions to the Fund, the city would not be liable to pay for services
provided by the WTCHP to its employees through city workers’ compensation or line-of-duty
injury programs.
Over the 10-year life of the program, the maximum federal spending in the Fund would be $4.59
billion and the maximum contribution from New York City would be $511 million, for a total of
$5.1 billion. Table A-2, in the Appendix, displays the maximum federal appropriation for each
fiscal year of the WTCHP. The annual amounts for a given year, and the total amounts, would be
less than the maximum authorized amounts if program costs for a given year were lower.
Eligibility for Benefits
Current MMTP
The current MMTP is open to all workers and volunteers who participated in rescue, recovery, or
other activities in response to the September 11, 2001, terrorist attack on the WTC as well as
lower Manhattan and Brooklyn residents, students, and others who were affected by the WTC
terrorist attacks. Because the MMTP is not authorized or established in statute, there are no
formal requirements in the law regarding program eligibility and no formal definitions of the
types or locations of activities that make a person eligible for the program.
The application form for the responder component of the MMTP indicates that, to be eligible, a
person must have provided “rescue, recovery, demolition, debris removal and related support
services” in the aftermath of the WTC attack.9 In addition, the application form requires
applicants to provide information on their work south of Canal Street in Manhattan, in the Port
Authority Trans-Hudson (PATH) transit tunnel, at the Staten Island landfill, on the barge loading
piers, or at the Office of the Chief Medical Examiner (OCME) during the period between
September 11, 2001, and July 2002.
The website of the community member component of the MMTP states that a person is eligible if
he or she lived, worked, commuted to, or was a student in lower Manhattan or “areas of
Brooklyn” on September 11, 2001, or participated in the cleanup of buildings in the “affected
area.”10
9 A copy of this application form is available online at http://www.wtcexams.org/pdfs/wtc_saef_v08.pdf.
10 The website of the community member component of the MMTP is available at http://www.nyc.gov/html/hhc/html/
services/wtc-qualifies.shtml.
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Proposed WTCHP
The WTCHP proposed by Title I of H.R. 847 would have eligibility requirements established by
law. No person on a terrorist watch list maintained by the Department of Homeland Security
would be eligible to participate in the WTCHP as a responder or survivor. Title I of H.R. 847
establishes the following groups of responders and survivors that would be eligible for the
WTCHP:11
Responders
A currently identified responder is an individual who has been identified as eligible for medical
monitoring under the MMTP.
A responder who meets current eligibility criteria is an individual who meets one of the following
conditions:
For members of the Fire Department of New York (FDNY) and associated persons:
• was a member, active or retired, of the FDNY who participated in at least one day
in the rescue or recovery effort at Ground Zero, the Staten Island landfill, or the
OCME during the period between September 11, 2001, and July 31, 2002; or
• is a surviving immediate family member of an FDNY member, retired or active,
who was killed at the WTC on September 11, 2001, and who received any
treatment for a WTC-related mental health condition on or before September 1,
2008.
For law enforcement, rescue, recovery, and cleanup workers:
• worked or volunteered in rescue, recovery, or cleanup services in lower
Manhattan below Canal Street, the Staten Island landfill, or the barge loading
piers, for at least four hours between September 11 and September 14, 2001; for
at least 24 hours between September 11, 2001, and September 30, 2001; or for at
least 80 hours between September 11, 2001, and July 31, 2002;
• was a member, active or retired, of the Police Department of New York City
(NYPD) or the Port Authority of New York and New Jersey Police, and
participated in rescue, recovery, or cleanup services in lower Manhattan below
Canal Street, the Staten Island landfill, or the barge loading piers, for at least four
hours between September 11, 2001, and September 14, 2001;
• was a member, active or retired, of the NYPD or the Port Authority of New York
and New Jersey Police, and participated in rescue, recovery, or cleanup services
at Ground Zero, the Staten Island landfill, or the barge loading piers for at least
one day between September 11, 2001, and July 31, 2002;
• was a member, active or retired, of the NYPD or the Port Authority of New York
and New Jersey Police, and participated on-site in rescue, recovery, debris
11 The proposed WTCHP uses the term “survivors” to refer to community members affected by the attack on the WTC
but not involved in rescue or other operations.
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cleanup, or related services in lower Manhattan (south of Canal Street) for at
least 24 hours between September 11, 2001, and September 30, 2001;
• was a member, active or retired, of the NYPD or the Port Authority of New York
and New Jersey Police, and participated in rescue, recovery, or cleanup services
in lower Manhattan below Canal Street for at least 24 hours between September
11, 2001, and September 30, 2001, or for at least 80 hours between September
11, 2001, and July 31, 2002;
• was an employee of the OCME involved in the examination and handling of
human remains from the WTC attacks, or other morgue worker who performed
similar functions, between September 11, 2001, and July 31, 2002;
• was a worker in the PATH transit tunnel for at least 24 hours between February 1,
2002, and July 1, 2002;
• was a vehicle maintenance worker who was exposed to debris from the former
WTC while working on vehicles contaminated by airborne toxins from the
September 11, 2001, attacks during work between September 11, 2001, and July
31, 2002; or
• worked or volunteered in rescue, recovery, demolition, debris cleanup, or other
related services at the site of the terrorist-related aircraft crashes of September 11,
2001, at the Pentagon or Shanksville, PA, for a period of time to be determined
by the WTCHP administrator; and is determined to be at an increased risk of
developing a WTC-related condition as a result of exposure or adverse conditions
resulting from the September 11, 2001, terrorist attacks.
A responder who meets modified eligibility criteria is an individual who performed rescue,
recovery, or cleanup services in the “New York City disaster area” in response to the September
11, 2001, attacks on the WTC, regardless of whether such services were performed by a state or
federal employee or member of the National Guard; and who meets eligibility criteria established
by the WTCHP administrator in consultation with the WTC Scientific/Technical Advisory
Committee established by the legislation.12
There would be a limit of 25,000 responders, not counting currently identified responders, that
may participate in the WTCHP, of which no more than 2,500 may be responders who meet
modified eligibility criteria.
Survivors
A currently identified survivor is a person, including a responder, who has been identified as
eligible for treatment and monitoring by the community component of the MMTP.
A survivor who meets current eligibility criteria is an individual who is not a WTC responder,
who claims symptoms of a WTC-related health condition, and who meets one of the following
criteria:
12 Title I of H.R. 847 defines the “New York City disaster area” as the area of Manhattan that is south of Houston Street
and the area of Brooklyn that is wholly or partially contained within a 1.5 mile radius of the former WTC site.
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• was present in the NYC disaster area in the dust or dust cloud on September 11,
2001;
• worked; resided; or attended school, child care, or adult day care in the New York
City disaster area for at least 4 days between September 11, 2001, and January
10, 2002; or at least 30 days between September 11, 2001, and July 31, 2002;
• worked as a cleanup worker in the New York City disaster area between
September 11, 2001, and January 10, 2002, and had extensive exposure to WTC
dust as a result of such work;
• was deemed eligible to receive a grant from the Lower Manhattan Development
Corporation Residential Grant Program, who possessed a lease for a residence or
purchased a residence in the New York City disaster area, and who resided in
such residence during the period between September 11, 2001, and May 31,
2003; or
• worked at a place of employment that at any time between September 11, 2001,
and May 31, 2003, was in the New York City disaster area, and that place of
employment was deemed eligible for a grant from the Lower Manhattan
Development Corporation WTC Small Firms Attraction and Retention Act
program, or similar program to revitalize the lower Manhattan economy.
A survivor who meets modified eligibility criteria is an individual who is not an eligible WTC
responder and who meets such eligibility criteria as determined by the WTCHP administrator in
consultation with the Data Centers, Advisory Committee, and steering committees established by
the legislation.
There would be a limit of 25,000 survivors, not counting currently indentified survivors, that may
participate in the WTCHP.
Covered Conditions
Current MMTP
Responders
The current MMTP provides benefits to eligible responders with covered medical conditions. The
list of covered medical conditions for responders is established by NIOSH and provided in Table
2.
Community Members
There is no formal list of covered medical conditions for eligible community members. However,
the website of the community member component of the MMTP provides the following list of
“common symptoms” for community members: (1) coughing, (2) wheezing, (3) shortness of
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breath, (4) sinus congestion, (5) stomach problems, (6) depression, (7) anxiety, and (8) other
symptoms.13
Table 2. Covered Conditions for Eligible Responders Under the WTC Medical
Monitoring and Treatment Program (MMTP)
Category Conditions
Aerodigestive disorders
(1) Interstitial lung diseases; (2) Chronic Respiratory Disorder –Fumes/Vapors; (3)
Asthma; (4) Reactive Airways Dysfunction Syndrome (RADS); (5) WTC-exacerbated
chronic obstructive pulmonary disease (COPD); (6) Chronic Cough Syndrome; (7)
Upper airway hyperreactivity; (8) Chronic rhinosinusitis; (9) Chronic nasopharyngitis;
(10) Chronic laryngitis; (11) Gastro-esophageal Reflux Disorder (GERD); and (12) Sleep
apnea exacerbated by or related to the above conditions.
Mental health conditions
(1) Post Traumatic Stress Disorder (PTSD); (2) Major Depressive Disorder; (3) Panic
Disorder; (4) Generalized Anxiety Disorder; (5) Anxiety Disorder (not otherwise
specified); (6) Depression (not otherwise specified); (7)Acute Stress Disorder; (8)
Dysthymic Disorder; (9) Adjustment Disorder; (10) Substance Abuse; and (11) “V
codes” (treatments not specifically related to psychiatric disorders, such as marital
problems, parenting problems etc.).a
Musculoskeletal disorders
(1) Low back pain; (2) Carpal Tunnel Syndrome (CTS); and (3) Other musculoskeletal
disorders.a
Source: Congressional Research Service (CRS). Information taken from the website of the MMTP at
http://www.wtcexams.org/.
Note: Clinical findings or other information must suggest that conditions are related to injury or exposure due
to the WTC attacks in order to be covered by the MMTP.
a. “V code” conditions would not be covered by the proposed World Trade Center Health Program
(WTCHP). In addition, only those musculoskeletal conditions that manifested on or before September 11,
2003, would be covered.
Proposed WTCHP
Title I of H.R. 847 provides lists of conditions covered by the responder and survivor component
of the proposed WTCHP. For all eligible responders and survivors, the list of covered conditions
includes all of the aerodigestive and mental health conditions currently covered by the MMTP
and listed in Table 2, with the exception that the proposed WTCHP would not cover mental
health conditions indentified by “V codes.”14 In addition, only those eligible responders who
received any treatment for a WTC-related musculoskeletal condition on or before September 11,
2003, would be eligible to have these conditions covered by the WTCHP.
Title I of H.R. 847 also provides administrative procedures for the WTCHP administrator to add
to the list of covered conditions for responders and survivors and provide coverage in the case of
a responder who has a WTC-related medical condition that is not on the list of covered
conditions. The WTCHP administrator would also be required to periodically review scientific
and medical evidence to determine if any type of cancer should be added to the list of covered
conditions for responders or survivors.
13 New York City Health and Hospitals Corporation, WTC Environmental Health Center: Common Symptoms,
http://www.nyc.gov/html/hhc/html/services/wtc-symptoms.shtml.
14 “V codes” include treatments not specifically related to psychiatric disorders, such as marital problems and parenting
problems.
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Benefits
Current MMTP
The current MMTP provides medical monitoring to all eligible responders and community
members, and medical treatment for covered conditions for eligible responders. Medical
monitoring includes initial screenings and annual exams. Medical treatment for covered
conditions is provided at no cost to the responder and includes in-patient and out-patient services,
medical procedures, and pharmaceuticals.
For eligible community members, the MMTP provides medical screening; however, medical care
for covered conditions is not necessarily provided. Rather, the MMTP provides assistance in
filling gaps when an eligible community member’s private or public insurance or other benefits
are not able to fully cover the costs of medical care for WTC-related conditions.
Proposed WTCHP
The WTCHP proposed by Title I of H.R. 847 would provide medical monitoring for eligible
responders, initial health evaluations for eligible survivors, and medical treatment for covered
conditions for all eligible responders and survivors. Medical treatment would include in-patient
and out-patient services, medical procedures, pharmaceuticals, and transportation to distant
medical appointments. For conditions that are work-related, the WTCHP would seek recoupment
of its costs from workers’ compensation programs. For conditions that are not work-related, the
WTCHP would be a secondary payer to any medical insurance, Medicaid, or the State Children’s
Health Insurance Program (SCHIP) that covers the participant, however, the WTCHP would be
primary payer for individuals covered by Medicare. Eligible responders and survivors would not
have any out-of-pocket costs for covered medical monitoring or treatment services. Beginning in
July 2014, responders and survivors would be required to have the minimum health insurance
coverage required under Section 5000A of the Internal Revenue Code of 1986.15
Provision of Medical Services
Current MMTP
The current MMTP uses four systems to provide medical services to eligible program
participants. For FDNY members and retired members, medical services are provided by the
FDNY Bureau of Health Services. For responders in the New York area, medical services are
provided by a network of clinics in New York City, Long Island, and New Jersey.16 Responders
who live outside of the New York area are provided services through a national network of
15 26 U.S.C. § 5000A. For additional information on the minimum health insurance coverage requirements of Section
5000A of the Internal Revenue Code of 1986, as established by the recently enacted health reform law, see CRS Report
R40942, Private Health Insurance Provisions in the Patient Protection and Affordable Care Act (PPACA), by Hinda
Chaikind et al..
16 These clinics are located in Manhattan (Mt. Sinai Medical Center and New York University School of Medicine-
Bellevue Hospital Center); Queens (Queens College); Staten Island (Richmond University Medical Center); Nassau
County, New York (State University of New York (SUNY)-Stony Brook); Suffolk County, New York (SUNY-Stony
Brook); and Piscataway, New Jersey (University of Medicine and Dentistry of New Jersey).
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providers managed by Logistic Health Incorporated. Medical benefits for community members
are provided by the New York City Health and Hospitals Corporation.
Proposed WTCHP
Medical benefits under the WTCHP proposed by Title I of H.R. 847 would be provided to all
eligible responders and survivors in the New York area through a network of clinical centers of
excellence determined by the program administrator to meet requirements provided in the
legislation. Eligible responders and survivors living outside of the New York area would receive
medical services through a national network of providers determined by the program
administrator to meet statutory requirements.
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Appendix. Funding Data for the WTC Medical
Monitoring and Treatment Program (MMTP) and
the Proposed World Trade Center Health Fund
Table A-1. Funding for the WTC Medical Monitoring and Treatment Program
dollars in millions
Fiscal
FY2011
Year
FY2002 FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 request
Amount 12.0 90.0
a
a 75.0 50.0 108.1 70.0 70.3 150.1
Source: Compiled by the Congressional Research Service (CRS). Appropriations acts that provided the funding
amounts are provided in CRS Report RL33927, Selected Federal Compensation Programs for Physical Injury or Death,
coordinated by Sarah A. Lister and C. Stephen Redhead, section on “World Trade Center Medical Monitoring
and Treatment Program.”
a. Funding for the WTC MMTP was not provided in FY2004 or FY2005. During these FYs, the program was
financed with appropriations from previous FYs.
Table A-2. Maximum Contributions to the Proposed World Trade Center
Health Fund
dollars in millions
Fiscal
Year
FY2011a FY2012 FY2013 FY2014 FY2015 FY2016 FY2017 FY2018 FY2019 FY2020 Total
Federal
spending
71 318 354 382 431 481 537 601 672 743
4,590
Source: CRS analysis of Title I of H.R. 847, the James Zadroga 9/11 Health and Compensation Act of 2010, as
amended.
Note: Numbers may not add due to rounding.
a. Amount is for the last calendar quarter of FY2011 only.
Author Contact Information
Scott Szymendera
Sarah A. Lister
Analyst in Disability Policy
Specialist in Public Health and Epidemiology
sszymendera@crs.loc.gov, 7-0014
slister@crs.loc.gov, 7-7320
Congressional Research Service
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