Rule2025-09411
World Trade Center (WTC) Health Program; Expanded Eligibility for Pentagon and Shanksville, Pennsylvania Responders
Primary source
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Published
May 27, 2025
Effective
May 27, 2025
Issuing agencies
Health and Human Services Department
Abstract
On September 11, 2024, CDC published in the Federal Register an interim final rule with request for comment to update existing regulations governing the WTC Health Program to align with statutory changes. The interim final rule expanded eligibility criteria for enrollment of new Pentagon and Shanksville responders, capped at 500 new members, and made various conforming amendments to the WTC Health Program regulations. In this final rule, CDC responds to public comment and finalizes the revisions to the regulation.
Full Text
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<title>Federal Register, Volume 90 Issue 100 (Tuesday, May 27, 2025)</title>
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[Federal Register Volume 90, Number 100 (Tuesday, May 27, 2025)]
[Rules and Regulations]
[Pages 22211-22213]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2025-09411]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
42 CFR Part 88
[Docket No. CDC-2024-0067; NIOSH-353]
RIN 0920-AA86
World Trade Center (WTC) Health Program; Expanded Eligibility for
Pentagon and Shanksville, Pennsylvania Responders
AGENCY: Centers for Disease Control and Prevention (CDC), Department of
Health and Human Services (HHS).
ACTION: Final rule.
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SUMMARY: On September 11, 2024, CDC published in the Federal Register
an interim final rule with request for comment to update existing
regulations governing the WTC Health Program to align with statutory
changes. The interim final rule expanded eligibility criteria for
enrollment of new Pentagon and Shanksville responders, capped at 500
new members, and made various conforming amendments to the WTC Health
Program regulations. In this final rule, CDC responds to public comment
and finalizes the revisions to the regulation.
DATES: This rule is effective on May 27, 2025.
FOR FURTHER INFORMATION CONTACT: Rachel Weiss, Public Health Analyst,
National Institute for Occupational Safety and Health, 1090 Tusculum
Avenue, MS: C-46, Cincinnati, OH 45226; telephone: (404) 498-2500 (this
is not a toll-free number); email: <a href="/cdn-cgi/l/email-protection#6b2522243823190e0c182b080f08450c041d"><span class="__cf_email__" data-cfemail="92dcdbddc1dae0f7f5e1d2f1f6f1bcf5fde4">[email protected]</span></a>.
SUPPLEMENTARY INFORMATION:
I. Public Participation
Interested parties were invited to participate in this rulemaking
by submitting written views, opinions, recommendations, and data on the
interim final rule published on September 11, 2024 (89 FR 73592). Two
comments were submitted to the rulemaking docket during the 30-day
comment period, both from interested individuals who are not members of
the WTC Health Program. The two comments are summarized in Section III.
II. Background
Title I of the James Zadroga 9/11 Health and Compensation Act of
2010 (Zadroga Act), as amended, revised the Public Health Service Act
(PHS Act) to establish the WTC Health Program (Program), which is
administered by the National Institute for Occupational Safety and
Health (NIOSH), within CDC. The WTC Health Program provides medical
monitoring and treatment to eligible responders to the September 11,
2001, terrorist attacks in New York City, at the Pentagon, and in
Shanksville, Pennsylvania, and to eligible survivors of the New York
City attacks. In this rulemaking, the Administrator of the WTC Health
Program and the Secretary of HHS finalize revisions of the implementing
regulation for the Program to align with the statutory changes to the
PHS Act.
A. WTC Health Program Statutory Authority
Title I of the Zadroga Act \1\ (Pub. L. 111-347, as amended by Pub.
L. 114-113, Pub. L. 116-59, Pub. L. 117-328, and Pub. L. 118-31) added
Title XXXIII to the PHS Act, codified at 42 U.S.C. 300mm-300mm-64,
establishing the WTC Health Program within HHS. All references to the
Administrator in this document mean the Director of NIOSH, within CDC,
or his or her designee.
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\1\ Those portions of the Zadroga Act found in titles II and III
of Public Law 111-347 do not pertain to the WTC Health Program and
are codified elsewhere.
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B. Regulatory Background
Following the enactment of the Zadroga Act, the HHS Secretary
promulgated 42 CFR part 88 to establish implementing regulations for
the WTC Health Program within NIOSH. The Zadroga Act prescribed
eligibility criteria for Pentagon and Shanksville, Pennsylvania
responders and required the Administrator to establish the dates
[[Page 22212]]
on which cleanup was concluded at the Pentagon and Shanksville sites,
respectively.\2\ The Administrator promulgated the eligibility criteria
and cleanup dates in 42 CFR 88.4(b) and (c) through a rulemaking
published on March 28, 2013.\3\ Following the rulemaking, eligible
Pentagon and Shanksville responders include those individuals who:
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\2\ 42 U.S.C. 300mm-21(a)(2)(C)(i)(I) and (II).
\3\ World Trade Center Health Program Eligibility Requirements
for Shanksville, Pennsylvania and Pentagon Responders, Interim Final
Rule, 78 FR 18855, March 28, 2013.
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<bullet> Were active or retired members of a fire or police
department (fire or emergency personnel), worked for a recovery or
cleanup contractor, or were volunteers; and
<bullet> Performed rescue, recovery, demolition, debris cleanup, or
other related services, either at the Pentagon site of the September
11, 2001, terrorist attacks, for at least 1 day beginning September 11,
2001, and ending on November 19, 2001, or at the Shanksville,
Pennsylvania site for at least 1 day beginning September 11, 2001, and
ending on October 3, 2001.
Since 2013, the WTC Health Program has enrolled 1,544 Pentagon
responders and Shanksville, Pennsylvania responders, combined but not
including those new members enrolled pursuant to the September 11, 2024
interim final rule.
In 2023, Congress identified a gap in coverage for the population
of employees of the Department of Defense (DOD) or other Federal
agencies, certain DOD and Federal agency contractors, and regular or
reserve uniformed service members who responded to the Pentagon and
Shanksville sites; these personnel did not previously meet the
statutory eligibility criteria in the Zadroga Act because of their
specific types of employment. Congress included language to address
these coverage gaps and expand eligibility criteria for responders at
the Pentagon and Shanksville, Pennsylvania sites in the National
Defense Authorization Act, 2024 (Pub. L. 118-31, December 22, 2023)
(2024 NDAA).
On September 11, 2024, the Administrator of the WTC Health Program
and the HHS Secretary amended part 88 to operationalize changes to
Title XXXIII of the PHS Act due to the 2024 NDAA. The agency published
an interim final rule with immediate effective date to quickly
implement the expanded eligibility criteria for Pentagon and
Shanksville responders. Specifically, the amendments to WTC Health
Program regulations in 42 CFR part 88 made by the interim final rule
included expanding eligibility criteria for Pentagon and Shanksville
responders, adding a numerical limit on Pentagon and Shanksville
responders enrolled under the new eligibility criteria, updating the
language in the regulation regarding the numerical limit on certain
newly enrolled WTC responders and certified-eligible survivors, and
updating and adding new definitions. An interim final rulemaking was
conducted because the agency determined that there was good cause to
waive public notice and comment prior to publication as the rulemaking
merely implemented the statutory changes. The agency determined it
would have been contrary to the public interest to delay the ability of
eligible individuals to access treatment for health conditions related
to their 9/11 response activities. No opposition to the expanded
eligibility requirements was anticipated and the agency did not
exercise any discretion in further defining certain employees who may
be eligible for the Program or clarify any additional limits on the
number of individuals from these categories who would be eligible.
Postponement of the implementation of the new eligibility criteria
could have resulted in harm to Pentagon and Shanksville responders
currently coping with one or more health conditions covered by the WTC
Health Program or who are at risk for developing such a condition.
Thus, notice and comment procedures were waived in the interest of
protecting the health of these responders and allowing them to apply
for enrollment in the WTC Health Program as soon as possible. Since
publication of the interim final rule, the Administrator of the WTC
Health Program welcomed 69 new members pursuant to the expanded
eligibility criteria as of April 23, 2025. The interim final rule
public comment period and Paperwork Reduction Act emergency information
collection request were open for 30 days, until October 11, 2024.
III. Summary of Public Comments
On September 11, 2024, the Administrator of the WTC Health Program
and the HHS Secretary published an interim final rule operationalizing
the 2024 NDAA amendments and expanding those groups eligible for
enrollment as responders at the Pentagon and Shanksville, Pennsylvania
sites. Two public comments were submitted to the rulemaking docket,
both supportive of the rulemaking.
Public comment: Of the two supportive public comments, one
expressed disappointment that the number of new Pentagon and
Shanksville enrollees is capped at 500 and asked for the agency's
rationale.
Agency response: As discussed above, Congress enacted the 2024 NDAA
to amend Title XXXIII of the PHS Act to expand eligibility criteria for
responders to the September 11, 2001, terrorist attacks at the Pentagon
and Shanksville, Pennsylvania sites. NDAA amendments codified in 42
U.S.C. 300mm-22(a)(4)(A)(ii) specify that the ``total number of
individuals who may be enrolled under [the expanded eligibility
criteria] shall not exceed 500 at any time.'' Accordingly, the agency
has no discretion to increase or decrease that limit in WTC Health
Program regulations and no change has been made in response to this
comment.
IV. Summary of Final Rule
No changes have been made to the final regulatory text, either in
response to public comment or at the agency's discretion. With this
rulemaking, and for the reasons discussed in the interim final rule,
amendments to 42 CFR part 88 are finalized as described below.
Authority Citation
The authority citation for 42 CFR part 88 was updated to reflect
recent amendments to Title I of the Zadroga Act (Pub. L. 111-347, as
amended by Pub. L. 114-113, Pub. L. 116-59, Pub. L. 117-328, and Pub.
L. 118-31). The statutory citation now reads 42 U.S.C. 300mm-300mm-64.
Section 88.1 Definitions
The statutory definitions of the terms Federal agency and uniformed
services were added to the existing Definitions section, 42 CFR 88.1.
In the existing definitions of Act and WTC Health Program, the
statutory authority citation was updated to reflect recent amendments
to the Zadroga Act.
Section 88.4 Eligibility Criteria--WTC Responders
The existing Pentagon responder eligibility criteria in 42 CFR
88.4(b) were modified to include the new statutory criteria for the
three new classes of eligible responders at the Pentagon site. For
clarity, the existing language in paragraph (b)(1) identifying classes
of eligible Pentagon responders was broken into new paragraphs,
designated (b)(1)(i) through (iii). New paragraphs (b)(1)(iv) through
(vi) were added to include the three new classes of eligible Pentagon
responders. New paragraph (b)(1)(iv) identifies employees
[[Page 22213]]
of the DOD or any other Federal agency; paragraph (b)(1)(v) identifies
employees of DOD contractors or other Federal agency contractors who
worked during the period beginning on September 11, 2001, and ending on
September 18, 2001; and paragraph (b)(1)(vi) identifies members of
regular and reserve components of the uniformed services. Language in
existing Sec. 88.4(b)(2) describing eligible response activities, time
periods, and duration of work was split into two paragraphs, resulting
in a revised paragraph (b)(2) and a new paragraph (b)(3).
The existing Shanksville, Pennsylvania responder eligibility
criteria in Sec. 88.4(c) were also revised to add the new statutory
criteria for the three new classes of eligible responders at the
Shanksville, Pennsylvania site. For clarity, the existing language
identifying classes of eligible Shanksville responders in paragraph
(c)(1) was broken into new paragraphs, designated (c)(1)(i) through
(iii). New paragraphs (c)(1)(iv) through (vi) were added to include the
three new classes of eligible Shanksville responders. New paragraph
(c)(1)(iv) identifies employees of the DOD or any other Federal agency;
paragraph (c)(1)(v) identifies employees of DOD contractors or other
Federal agency contractors who worked during the period beginning on
September 11, 2001, and ending on September 18, 2001; and paragraph
(c)(1)(vi) identifies members of regular and reserve components of the
uniformed services. Language in existing paragraph (c)(2) describing
eligible response activities, time periods, and duration of work was
split into two paragraphs, resulting in a revised paragraph (c)(2) and
a new paragraph (c)(3).
Section 88.6 Enrollment Decision--WTC Responders
In 42 CFR 88.6, existing paragraph (c) establishes conditions under
which the WTC Health Program may deny enrollment of responders. In
paragraph (c)(2)(i), the numerical limit on new WTC responder
enrollment was replaced with new language indicating that this limit is
established in the Zadroga Act, as amended. Language in paragraph
(c)(2)(i) describing the Administrator's discretion regarding whether
to close Program enrollment in the event that sufficient funds are not
available to enroll new members was moved to a new paragraph
(c)(2)(iii) without change. New text in paragraph (c)(2)(ii) reflects
the new statutory limit of 500 total WTC responders who may be enrolled
pursuant to the expanded Pentagon and Shanksville, Pennsylvania
eligibility criteria in Sec. Sec. 88.4(b)(1)(iv) through (vi) and
88.4(c)(1)(iv) through (vi), respectively.
Section 88.12 Enrollment Decision--Certified-Eligible Survivors
In 42 CFR 88.12, existing paragraph (b)(3) establishes conditions
under which the WTC Health Program may deny certified-eligible survivor
status. The numerical limit in paragraph (b)(3)(i) was replaced with
new language indicating that the limit on certified-eligible survivor
enrollment is specified in the Zadroga Act, as amended. Language in
existing paragraph (b)(3)(i), describing the Administrator's discretion
regarding whether to close Program enrollment in the event that
sufficient funds are not available to enroll new members, was moved to
a new paragraph (b)(3)(ii) without change.
List of Subjects in 42 CFR Part 88
Administrative practice and procedure, Cancer, Diseases,
Firefighters, Health, Health care, Mental health programs, Law
enforcement officers, Lung diseases, Occupational safety and health,
Volunteers, Workers' compensation.
Accordingly, the interim final rule amending 42 CFR part 88, which
published on September 11, 2024 (89 FR 73592), is adopted as a final
rule without change.
John J. Howard,
Administrator, World Trade Center Health Program and Director, National
Institute for Occupational Safety and Health, Centers for Disease
Control and Prevention, Department of Health and Human Services.
Robert F. Kennedy, Jr.,
Secretary, Department of Health and Human Services.
[FR Doc. 2025-09411 Filed 5-23-25; 8:45 am]
BILLING CODE 4163-18-P
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