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National Association for Home Care & Hospice
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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

Hospice Claims and Use of Debility, Adult Failure to Thrive, and Dementia Diagnoses

CMS expects that hospices not use ‘debility’ and ‘adult failure to thrive’ as the primary diagnosis on hospice claims effective immediately.
May 10, 2013 08:45 AM

In the April 30, 2013 edition of NAHC Report, a summary was provided for the FY2014 Hospice Wage Index proposal that included some details of the portion of the proposed rule related to multiple diagnoses on hospice claims and specifically hospices’ use of ‘debility’, ‘adult failure to thrive’, and dementia as the principal diagnosis. 

CMS indicated that hospices should not use these diagnoses as the principal diagnosis, and that in the future they will return to provider (RTP) claims with ‘debility’ or ‘adult failure to thrive’ as the principal diagnoses.  In the CMS Open Door Forum (ODF) on May 8, 2013 CMS indicated that instruction to contractors for RTPing these claims would be coming out soon.  No particular date was given but it is clear that CMS has warned providers about the need to RTP claims and that providers should not be coding these diagnoses as the principal diagnosis. 

NAHC strongly recommends that all hospices review each case where ‘debility’ or ‘adult failure to thrive’ is listed as the principal diagnosis.

If those cases clearly have another diagnosis that is considered as a principal diagnosis, the hospice should change this for all future claims.  It is possible that there is not a more specific principal diagnosis and the ICD-9 coding conventions do allow ‘debility’ and ‘adult failure to thrive’ when another more specific diagnosis is not present.  Because of this it is of great concern to hospices that CMS will RTP any claims with ‘debility’ and ‘adult failure to thrive’ in the principal diagnosis field.  However, at this time CMS clearly expects and is strongly communicating to hospices that these diagnoses not be the principal diagnosis.

In addition to adult failure to thrive and debility, CMS also clarified for providers that use of dementia and some other mental, behavioral, and neurodevelopmental disorders as a principal diagnosis is not appropriate.  CMS indicates that the ICD-9-CM has a coding convention that requires the underlying condition be sequenced first, followed by the manifestation. CMS underscores that it expects hospice providers to follow ICD-9-CM coding guidelines and sequencing rules for all diagnoses and pay particular attention to the specified conventions for dementia codes as depending on the code they may or may not be used as principal diagnosis. 

CMS also reiterated in the ODF the expectation that hospices observe longstanding policy of including all diagnoses related to the principal diagnosis on the hospice claim.  This is the third time CMS has made this clarification, and they emphasized how serious they are about this issue. 

CMS also referenced comments made in the 1983 hospice final rule: 

“We are restating what we communicated in the December 16, 1983 final rule regarding what is related versus unrelated to the terminal illness: ...we believe that the unique physical condition of each terminally ill individual makes it necessary for these decisions to be made on a case–by-case basis. It is our general view that ... hospices are required to provide virtually all the care that is needed by terminally ill patients (48 FR 56010 through 56011). Therefore, unless there is clear evidence that a condition is unrelated to the terminal illness, all services would be considered related. It is also the responsibility of the hospice physician to document why a patient’s medical need(s) would be unrelated to the terminal illness.”

A very detailed analysis of the section of the proposed rule, FY2014 Hospice Wage Index Update, related to multiple diagnoses will be distributed soon by NAHC and HAA.

NAHC strongly encourages hospice providers to ensure they are including all related diagnoses on their claims and that they are following all ICD-9-CM coding guidelines and sequencing rules now.   

NAHC is planning further education on these diagnoses and the coding of related diagnoses for the near future.  Please direct questions and comments to Theresa Forster, and Katie Wehri




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