Some Useful Terms to Know for Survivors in the WTC Health Program

The WTC Health Program has its own lingo, and it can take some time to learn all of it. Understanding the terminology, however, is an important part of making sure you’re getting everything you can out of the program. Here are some key terms from the WTC Health Program Handbook’s glossary that might come in handy on your first visit:

Annual Monitoring Exam/Medical 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.

Authorization: Permission from your doctor, your CCE or the NPN, or the Program for a specific treatment or service to be covered under the Program; often referred to as a Level 1, Level 2, or Level 3 Authorization.

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-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.

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. 

MCA-Sedgwick: As of August 1st, 2022, the administrator that manages the Nationwide Provider Network 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.

Logistics Health Incorporated (LHI): The former administrator of the Nationwide Provider Network. Their contract ended on August 1st, 2022.

Medical Benefits Team: The WTC Health Program staff who oversee medical benefits for Program members and make initial decisions about treatment authorizations for members. 

Member: A WTC Responder or WTC Survivor who has been found eligible for the Program and enrolled. 

Nationwide Provider Network (NPN): A nationwide network of health care providers across the country under contract with the Program to provide WTCrelated health care for Program members who live outside the NY Metropolitan Area and want to receive their 9/11 health care locally.

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.

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.

WTC-related Health Condition: 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, terrorists 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 mental health condition. Only those conditions on the List of WTC-Related Health Conditions codified in 42 C.F.R. § 88.15 may be considered WTC-related health conditions and a health condition must be certified by the Program to be eligible for coverage.