World Trade Center Health Program:

Potential Effects of Implementation Options

GAO-11-735R: Published: Aug 4, 2011. Publicly Released: Aug 4, 2011.

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The James Zadroga 9/11 Health and Compensation Act of 2010 became law on January 2, 2011, and established a World Trade Center Health Program (WTCHP) to assume the functions of the World Trade Center (WTC) responder health programs beginning on July 1, 2011. From September 11, 2001, through fiscal year 2010, approximately $475 million in federal funds was made available for screening, monitoring, and treating WTC responders for illnesses and conditions related to the WTC disaster. These include asthma, persistent coughing, and other respiratory conditions and mental health conditions such as depression, anxiety, and post-traumatic stress disorder (PTSD). The three federal programs that provided screening, monitoring, and treatment services to responders prior to July 1, 2011, which we refer to here as the WTC responder health programs, were the New York City Fire Department's (FDNY) WTC Medical Monitoring and Treatment Program, the New York/New Jersey (NY/NJ) WTC Consortium, and the WTC National Responder Health Program. The WTCHP is administered by HHS and provides screening, monitoring, and treatment services through contracted clinical centers in the NYC area for responders in that area and through a nationwide network of providers for responders outside the NYC area. In addition to these health services, the WTCHP is required to establish a program to pay for prescription drugs prescribed under the program and to contract with one or more data centers to coordinate patient outreach and, by analyzing claims data, conduct research on WTC-related health conditions. Although the Zadroga Act generally provides that the WTCHP is the primary payer for benefits for responders under the WTCHP, the act establishes the WTCHP as a secondary payer in certain circumstances. In May 2011, HHS delegated authority to the Centers for Medicare & Medicaid Services to provide payment services for the WTCHP. All other WTCHP activities will be administered by Centers for Disease Control and Prevention's (CDC) National Institute for Occupational Safety and Health (NIOSH). In April 2011, NIOSH issued a solicitation for clinical centers to provide health services to responders and a solicitation for one or more data centers to provide case management and increased capacity for analysis of responder health conditions; on July 1, 2011, NIOSH awarded contracts to six clinical centers and two data centers. The Zadroga Act established the WTCHP Fund and provided appropriations for the federal share of expenditures for each of fiscal years 2012 through 2016, as well as the last calendar quarter of fiscal year 2011, totaling a maximum of $1.6 billion. The Zadroga Act requires us to study feasibility, efficiency, and effectiveness issues related to the WTCHP established by the act, including the WTCHP's potential use of one consolidated data center rather than multiple data centers, the potential use of Department of Veterans Affairs (VA) health care facilities to serve WTC responders outside the NYC area, and the potential use of an existing federal prescription drug purchasing program to provide prescription drugs for all WTC responders. The act expressly authorizes (but does not require) the WTCHP to enter into an agreement with VA to provide WTCHP services to responders living outside the NYC area through VA facilities. However, the act does not expressly authorize an agreement with a federal prescription drug purchasing program to provide prescription drugs to WTC responders. In this report, we identify potential effects of (1) creating a consolidated data center for the WTCHP, (2) using VA facilities to provide WTCHP services to responders living outside the NYC area, and (3) using an existing federal prescription drug purchasing program for the WTCHP.

Creating a consolidated data center could lead to cost savings and enhanced research opportunities; however, consolidation could require upfront expenditures. In addition, establishing a consolidated data center could result in a loss of responders' clinical data from the WTCHP because of the potential need to have responders sign new consent forms to enable use of their data for research. Responders provided consent to their respective clinical centers to send their clinical data to the center's DCC for research purposes, and existing consent might not authorize the use of such data by a consolidated data center. Responders might be unavailable or unwilling to provide consent again. Although most WTC responders outside the NYC area live near a VA facility, the use of VA facilities for the WTCHP could affect access to health services for WTC responders because not all types of clinical expertise are available at all VA facilities, VA facilities do not always have space available to serve nonveterans, and it would take an undetermined length of time to implement an agreement between VA and HHS. The use of VA facilities for the WTCHP could also affect enrollment retention because WTC responders might need to change health care providers. Providing prescription drugs to WTC responders through an existing federal prescription drug purchasing program could reduce drug prices. It might also affect the availability of options for filling prescriptions and responders' access to certain prescription drugs. In addition, VA and DOD officials told us that use of their respective drug purchasing programs for WTC responders would require administrative changes to their programs. In written comments, DOD concurred with a draft of this report. HHS and VA provided technical comments, which we incorporated as appropriate.

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