The WTC Health Registry is also collecting  information to assess the long-term public health consequences of the  disaster. WTC Federal Responder Screening Program Has Had Difficulties Ensuring the Availability of Screening Services and Is Not Designed to Provide Monitoring

HHS’s WTC Federal Responder Screening Program has not ensured the  uninterrupted availability of screening services for federal responders. 1). From  January to May 2007, FOH, the program’s implementing agency, did not  schedule screening examinations for federal responders. This interruption  in service occurred because there was a change in the administration of  the WTC Federal Responder Screening Program, and certain interagency  agreements were not established in a timely way to keep the program fully  operational. The WTC Federal Responder Screening Program stopped  scheduling and paying for these specialty diagnostic services for almost a  year, from April 2006 to March 2007. The  contract with the new provider network did not cover specialty diagnostic  services by ear, nose, and throat doctors; cardiologists; and  pulmonologists. Almost a year later, in March 2007, FOH modified its contract with  the provider network and resumed scheduling and paying for specialty  diagnostic services for federal responders. The WTC Federal Responder Screening Program was designed to provide  a onetime screening examination; however, NIOSH officials told us they  want to expand the program to offer monitoring examinations—that is,  follow-up physical and mental health examinations—to federal  responders. NIOSH Has Not Ensured the Availability of Services for Nonfederal Responders Residing outside the NYC Metropolitan Area

NIOSH has not ensured the availability of screening and monitoring  services for nonfederal responders residing outside the NYC metropolitan  area, although it recently took steps toward expanding the availability of  these services. The first effort, in which NIOSH  arranged for AOEC to provide screening services, began in late 2002 and  ended in July 2004. In June 2005, NIOSH began its second effort by  awarding funds to Mount Sinai’s DCC to provide both screening and  monitoring services. However, these efforts are incomplete. From August 2004 until June 2005, NIOSH did not fund any organization to  provide screening or monitoring services outside the NYC metropolitan  area for nonfederal responders. DCC, however, had difficulty establishing a  network of providers that could serve nonfederal responders residing  throughout the country—ultimately contracting with only 10 clinics in 7  states to provide screening and monitoring services. In May 2007, NIOSH took steps toward establishing the national program,  but its efforts are incomplete. CDC’s NIOSH Awarded Funding for Treatment Services to Four WTC Health Programs, but Does Not Have a Reliable Estimate of Service Costs

In fall 2006, CDC’s NIOSH awarded $44 million to four programs in the  NYC metropolitan area for providing outpatient treatment services to  responders. NIOSH has worked with two of its grantees to estimate the cost of  monitoring and treating responders; however, the most recent effort, in  2007, has not produced reliable results because the estimate included  potential costs for certain program changes that may not be implemented  as well as some costs that reduced the estimate’s accuracy. NIOSH Awarded $44 Million in Outpatient Treatment Funding, Which Is Expected to Be Spent by End of Fiscal Year 2007, and Set Aside $7 Million for Hospital Care

In fall 2006, NIOSH awarded and set aside funds totaling $51 million from  its $75 million appropriation for four WTC health programs in the NYC  metropolitan area to provide treatment services to responders enrolled in  these programs. In  the absence of actual cost data, NIOSH and its grantees relied on workers’  compensation reimbursement rates for specific services as a proxy for  outpatient treatment costs. It is  unclear whether the overall estimate overstated or understated the costs  of monitoring and treating responders. HHS Officials Have Taken Steps to Develop More Reliable Cost Estimates

To improve the reliability of future efforts to estimate the cost of providing  services to responders, NIOSH officials and the Assistant Secretary for  Health—in his capacity as chairman of the HHS WTC Task Force—have  required the FDNY WTC program and NY/NJ WTC Consortium to report  detailed demographic, service utilization, and cost information. At that time we will send copies of this report to the Secretary  of Health and Human Services, congressional committees, and other  interested parties.
Why GAO Did This Study

Responders to the World Trade Center (WTC) attack were exposed to many hazards, and concerns remain about long-term health effects of the disaster and the availability of health care services for those affected. In 2006, GAO reported on problems with the Department of Health and Human Services' (HHS) WTC Federal Responder Screening Program and on the Centers for Disease Control and Prevention's (CDC) distribution of treatment funding. GAO was asked to update its 2006 testimony. GAO assessed the status of (1) services provided by the WTC Federal Responder Screening Program, (2) efforts by CDC's National Institute for Occupational Safety and Health (NIOSH) to provide services for nonfederal responders residing outside the New York City (NYC) area, and (3) NIOSH's awards to grantees for treatment services and efforts to estimate service costs. GAO reviewed program documents and interviewed HHS officials, grantees, and others.

What GAO Found

HHS's WTC Federal Responder Screening Program has had difficulties ensuring the uninterrupted availability of services for federal responders. From January 2007 to May 2007, the program stopped scheduling screening examinations because there was a change in the administration of the WTC Federal Responder Screening Program, and certain interagency agreements were not established in a timely way to keep the program fully operational. In April 2006 the program also stopped scheduling and paying for specialty diagnostic services because a contract with the program's new provider network did not cover these services. Almost a year later, the contract was modified, and the program resumed scheduling and paying for these services in March 2007. NIOSH is considering expanding the WTC Federal Responder Screening Program to include monitoring--follow-up physical and mental health examinations--and is assessing options for funding and service delivery. If federal responders do not receive monitoring, health conditions that arise later may not be diagnosed and treated, and knowledge of the health effects of the WTC disaster may be incomplete. NIOSH has not ensured the availability of screening and monitoring services for nonfederal responders residing outside the NYC area, although it recently took steps toward expanding the availability of these services. In late 2002, NIOSH arranged for a network of occupational health clinics to provide screening services. This effort ended in July 2004, and until June 2005, NIOSH did not fund screening or monitoring services for nonfederal responders outside the NYC area. In June 2005, NIOSH funded the Mount Sinai School of Medicine Data and Coordination Center (DCC) to provide screening and monitoring services; however, DCC had difficulty establishing a nationwide network of providers and contracted with only 10 clinics in 7 states. In 2006, NIOSH began to explore other options for providing these services, and in May 2007, it took steps toward expanding the provider network. However, these efforts are incomplete. NIOSH has awarded treatment funds to four NYC-area programs, but does not have a reliable cost estimate of serving responders. In fall 2006, NIOSH awarded $44 million for outpatient treatment and set aside $7 million for hospital care. The New York/New Jersey WTC Consortium and the New York City Fire Department WTC program, which received the largest awards, used NIOSH's funding to continue outpatient services, offer full coverage for prescriptions, and cover hospital care. Program officials expect that NIOSH's outpatient treatment awards will be spent by the end of fiscal year 2007. NIOSH lacks a reliable estimate of service costs because the estimate that NIOSH and its grantees developed included potential costs for certain program changes that may not be implemented, and in the absence of actual treatment cost data, they relied on questionable assumptions. It is unclear whether the estimate overstates or understates the cost of serving responders. To improve future cost estimates, HHS officials have required the two largest grantees to report detailed cost data.