42 CFR 88.12 – Enrollment decision–certified-eligible survivors
(a) The WTC Health Program will prioritize certification requests in the order in which they are received.
Terms Used In 42 CFR 88.12
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
(b) The WTC Health Program will review the physician’s determination, render a decision regarding certification of the individual’s WTC-related health condition, and notify the individual of the decision and the reason for the decision in writing, pursuant to §§ 88.17 and 88.18.
(1) If the individual is a screening-eligible survivor and the individual’s condition is certified as a WTC-related health condition, the individual will automatically receive the status of a certified-eligible survivor.
(2) If a screening-eligible survivor’s condition is not certified as a WTC-related health condition pursuant to §§ 88.17 and 88.18, the WTC Health Program will deny certified-eligible status. The screening-eligible survivor may appeal the decision to deny certification, as provided under § 88.21.
(3) The WTC Health Program may deny certified-eligible survivor status of an otherwise eligible and qualified screening-eligible survivor if the Act’s numerical limitations for certified-eligible survivors have been met.
(i) No more than 25,000 individuals, other than those described in § 88.7, may be determined to be certified-eligible survivors at any time. The Administrator of the WTC Health Program may decide, based on the best available evidence, that sufficient funds are available under the WTC Health Program Fund to provide treatment and monitoring only for individuals who have already been certified as certified-eligible survivors at that time.
(ii) [Reserved]
(4) No individual who is determined to be a positive match to the terrorist watch list maintained by the Federal government may qualify to be a certified-eligible survivor in the WTC Health Program.