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In the various roles he has undertaken through the years, Val J. Halamandaris has been a singular driving force behind the policy and program initiatives resulting in the recognition of home health care as a viable alternative to institutionalization. His dedication to consumer advocacy, which enhances the quality of life and dignity of those receiving home health care, merits VNA HealthCare Group’s highest recognition and deepest respect. 

VNA HealthCare Group

I have the highest respect for them, especially for the nurses, aides and therapists, who devote their lives to caring for people with disabilities, the infirm and dying Americans.  There are few more noble professions.

President Barack Obama

Home health care agencies do such a wonderful job in this country helping people to be able to remain at home and allowing them to receive services

U.S. Senator Debbie Stabenow (D-MI) Chair, Democratic Steering and Outreach Committee

Home care is a combination of compassion and efficiency.  It is less expensive than institutional care...but at the same time it is a more caring, human, intimate experience, and therefore it has a greater human’s a big mistake not to try to maximize it and find ways to give people the home care option over either nursing homes, hospitals or other institutions

Former Speaker of the U.S. House of Representatives Newt Gingrich (R-GA)

Medicaid covers long-term care, but only for low-income families.  And Medicare only pays for care that is connected to a hospital discharge....our health care system must cover these vital services...[and] we should promote home-based care, which most people prefer, instead of the institutional care that we emphasize now.

Former U.S. Senator Majority Leader Tom Daschle (D-CD)

We need incentives to...keep people in home health care settings...It’s dramatically less expensive than long term care.

U.S. Senator John McCain (R-AZ)


Home care is clearly the wave of the future. It’s clearly where patients want to be cared for. I come from an ethnic family and when a member of our family is severely ill, we would never consider taking them to get institutional care. That’s true of many families for both cultural and financial reasons. If patients have a choice of where they want to be cared for, where it’s done the right way, they choose home.

Donna Shalala, former Secretary of Health and Human Services

A couple of years ago, I spent a little bit of time with the National Association for Home Care & Hospice and its president, Val J. Halamandaris, and I was just blown away. What impressed me so much was that they talked about what they do as opposed to just the strategies of how to deal with Washington or Sacramento or Albany or whatever the case may be. Val is a fanatic about care, and it comes through in every way known to mankind. It comes through in the speakers he invites to their events; it comes through in all the stuff he shares.

Tom Peters, author of In Search of Excellence

Val’s home care organization brings thousands of caregivers together into a dynamic organization that provides them with valuable resources and tools to be even better in their important work. He helps them build self-esteem, which leads to self-motivation.

Mike Vance, former Dean of Disney and author of Think Out of the Box

Val is one of the greatest advocates for seniors in America. He goes beyond the call of duty every time.

Arthur S. Flemming, former Secretary of Health, Education, and Welfare

Val has brought the problems, the challenges, and the opportunities out in the open for everyone to look at. He is a visionary pointing the direction for us. 

Margaret (Peg) Cushman, Professor of Nursing and former President of the Visiting Nurses Association

Although Val has chosen to stay in the background, he deserves much of the credit for what was accomplished both at the U.S. Senate Special Committee on Aging, where he was closely associated with me and at the House Select Committee on Aging, where he was Congressman Claude Pepper’s senior counsel and closest advisor. He put together more hearings on the subject of aging, wrote more reports, drafted more bills, and had more influence on the direction of events than anyone before him or since.

Frank E. Moss, former U.S. Senator

Val’s most important contribution is pulling together all elements of home health care and being able to organize and energize the people involved in the industry.

Frank E. Moss, former U.S. Senator

Anyone working on health care issues in Congress knows the name Val J. Halamandaris.

Kathleen Gardner Cravedi, former Staff Director of the House Select Committee on Aging

Without your untiring support and active participation, the voices of people advocating meaningful and compassionate health care reform may not have been heard by national leaders.

Michael Sullivan, Former Executive Director, Indiana Association for Home Care

All of us have been members of many organizations and NAHC is simply the best there is. NAHC aspires to excellence in every respect; its staff has been repeatedly honored as the best in Washington; the organization lives by the highest values and has demonstrated a passionate interest in the well-being of patients and providers.

Elaine Stephens, Director of Home Care of Steward Home Care/Steward Health Systems and former NAHC C

Home care increasingly is one of the basic building blocks in the developing system of long-term care.  On both economic and recuperative bases, home health care will continue to grow as an essential service for individuals, for families and for the community as a whole.

Former U.S. Senator Olympia Snowe (R-ME)

NCOA is excited to be part of this great event and honored to have such influential award winners in the field of aging.

National Council of Aging

Health care at home…is something we need more of, not less of.  Let us make a commitment to preventive and long-term care.  Let us encourage home care as an alternative to nursing homes and give folks a little help to have their parents there.

Former President Bill Clinton

MedPAC Discusses Hospice Policy and Payment Options – Advances “Initial Step” on Hospice Payment Reform, Other Ideas

April 5, 2013 03:40 PM

The Medicare Payment Advisory Commission (MedPAC) met on Thursday, April 4, to discuss a variety of issues affecting Medicare. The meeting included a lengthy session on Medicare hospice policy issues, and was the first time in many months that MedPAC staff addressed hospice payment issues in-depth - including reform of the payment system and payment for services to hospice patients in nursing facilities. The panel also discussed findings and concerns related to live discharges.

Here is a link to the meeting’s presentation slides. 

A transcript of the session is usually available within five days of the meeting being held.

Below is an overview of the relevant hospice topics covered during the meeting:

Payment Reform:  MedPAC staff indicated that available data represents about 68 percent of direct labor costs, and suggested that an initial step in payment reform could be taken by adjusting 68 percent of the per diem rate according to a u-shaped model, while keeping the remainder of the per diem payment flat.  Under the example they used, the relative weights and daily payments would be as follows:

MedPAC Example of Potential Revised Payment System


Relative weight

Per diem payment rate adjusting 68% of base rate ($153)

Percent change from the current rate

1 to 7




8 to 14




15 to 30








Each of last 7 days

1.15 add-on to applicable weight above

$120 add-on to applicable rate above

68% - 144% depending on LOS


The following table demonstrates an impact analysis of the proposed “initial” step payment model on financial margins for freestanding agencies. 

Impact of Illustrative Payment Model by Length of Stay

Provider quintile: share of cases > 180 days

Percent change in payments (all hospices)

Actual 2010 margin (freestanding)

Estimated 2010 margin w/illustrative model (freestanding)






















NOTE:  Under the illustrative model, payments would increase by more than 2 percent for the majority of provider-based (70 percent), nonprofit (61 percent), and rural (52 percent) hospices

While the average margin of providers with (proportionally) the largest number of long-stay patients remains high, it is substantially reduced. The financial margin for the quintile of providers with the lowest proportionate share of long-stay patients would increase significantly, as well.  While the margin differential between the lowest and highest quintile of providers with long-stay patients remains large, it is diminished over the actual 2010 margin figures.

Live Discharges:  While MedPAC has looked at long-stay patients before, more recently they have been conducting staff analysis of live discharges.  In 2010, 14 percent of hospice episodes - 1.2 million - ended in live discharge.  MedPAC data indicates that for-profit hospices are 20 percent more likely to discharge patients alive while above-cap hospices are twice as likely as hospices below the cap to discharge patients alive.  MedPAC analysis also indicates that most patients with long stays in hospice that end in live discharge also had long survival post-discharge.  For patients with long stays before discharge, average post-discharge spending is less than the hospice payment rate, although these patients did experience high-level spending in the last days of life.  Staff concluded that the findings support ensuring that patients are appropriate candidates before admission and throughout long episodes. 

Hospice/Nursing Facilities:  MedPAC has continued its analysis of hospice care provided in nursing facilities and has found that nursing facility residents receive more aide visits from hospice than hospice patients at home.  If the same amount of aide visits were provided in the facility as at home, average labor costs for all types of visits combined would be 4 to7 percent lower in nursing facilities than in the home.  As an option, staff indicated that MedPAC could consider recommending reducing a portion of the hospice payment rate in nursing facilities based on estimates of the labor cost of visits in the two settings assuming and equal provision of aide visits; this would reduce hospice payments in nursing facilities by 3 to 5 percent. 

NAHC Reportand HAA’s Hospice Notes will continue to updates its readers regarding further developments related to MedPAC activities related to hospice policy.





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