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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

Diagnoses on Hospice Claims – Further Clarification

May 28, 2013 03:09 PM

Since the fiscal year (FY) 2014 Hospice Wage Index proposal was posted just several weeks ago, hospices have been asking numerous questions about the Centers for Medicare & Medicaid Services’ (CMS) clarification of diagnoses on hospice claims - and hospices have been debating answers to the numerous questions and what steps hospices should take to be in full compliance with CMS’ expectations. 

One of the most frequently asked questions is “When will Medicare’s Administrative Contractors (MACs) begin returning to provider (RTP) hospice claims that have ‘adult failure to thrive’ or ‘debility’ as the principal diagnosis?” 

In a recent Open Door Forum (ODF), CMS indicated this would be “soon” and instructions to MACs were “in process." Since the ODF, the National Association for Home Care & Hospice (NAHC) has clarified with CMS that it will use the same process used for all instructions to MACs.  This means the instructions will be delivered via a Change Request (CR).  The CR will include an effective date and an implementation date - as all CRs do - but NAHC does not yet know exactly how much time there will be between the release of the CR and its implementation date and effective date. 

In the proposed rule, CMS indicated that it is seeking comments about these diagnoses but we are not certain that CMS will wait until after those comments are received and reviewed before releasing the CR.  It is, however, NAHC's understanding from CMS that all claims RTP’d will be for a date in the future. There will be no retrospective returns to provider.  Again, at this time the only change that CMS has indicated will occur in the near future is that hospice claims with ‘adult failure to thrive’ or ‘debility’ as the principal diagnosis will be RTP’d.  The purpose of returning the claim to the provider is so CMS can request the hospice to use a different, more specific and causative, diagnosis as the principal diagnosis.  If the hospice cannot provide a different, more specific diagnosis we expect the claim will be denied.

CMS has clearly stated that hospices need to use the ICD-9 coding guidelines when determining the principal diagnosis and all other diagnoses.  This has been very confusing to hospices, in part, because some MACs use diagnosis-specific LCDs as criteria for hospice eligibility and some have LCDs for ‘adult failure to thrive’ and ‘debility’.  CMS stressed to NAHC that hospice eligibility is determined by a patient’s prognosis not a patient’s diagnosis. 

NAHC and HAA fully understand the confusion hospices are experiencing as well as the need for hospices to follow ICD-9 coding guidelines.  Hence, both organizations will continue to work on developing educational resources to assist hospices. 

In the interim, It is suggested that hospices thoroughly review each case where ‘debility’ or ‘adult failure to thrive’ is listed as the principal diagnosis, and code the diagnosis that is most contributory to the debility or the adult failure to thrive as the principal diagnosis for all future claims. 

There has been some concern from hospices that the most contributory diagnosis is not always a “hospice diagnosis” - and that the hospice and the hospice physician is not comfortable putting the “non-hospice diagnosis” on the claim as the principal diagnosis. 

It is the prognosis of the patient that determines eligibility and not the diagnosis and the hospice needs to follow the ICD-9 coding guidelines and code the most contributory diagnosis as the principal diagnosis.

There remain questions about how the MACs may modify their LCDs and corresponding education to providers upon the release of the anticipated CR on this subject.  CMS made it clear in the ODF that national guidance supersedes any local coverage determinations.  We also understand that there remain questions about the impact on the certification of terminal illness (CTI) in cases where a diagnosis of ‘adult failure to thrive’ or ‘debility’ needs to be changed in accordance with ICD-9 coding guidelines.  NAHC and HAA continue to seek guidance in this area as well as other areas where clarity is needed. 

NAHX and HAA also continue to seek guidance and provide education regarding the listing of multiple diagnoses on hospice claims – the principal diagnosis and all related diagnoses. 

NAHC and HAA need information from hospices.

Specifically, please share with us the following:

1. If utilizing an EMR, is the system able to differentiate between related and unrelated diagnoses and only put related diagnoses on the claim?

2. Specific clinical conditions of cases in which a patient is clearly terminal but a diagnosis more specific than adult failure to thrive or debility does not appear to be present.

Please provide us with this information as soon as possible. You can submit it to Theresa Forster,, or Katie Wehri, 




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