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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

NOMNC Manual Instructions Issued

May 31, 2013 03:19 PM

Transmittal 2711 was recently published by the Centers for Medicare & Medicaid Services (CMS). The transmittal updates Chapter 30, Sections 260 through 261 of the Medicare Claims Processing Manual. The update reflects provisions of the final rule that became effective July 2005 and offers operating guidance for the Expedited Determination Notice (ED) for termination of Medicare covered services via the Notice of Medicare Non-Coverage (NOMNC). 

Despite longstanding notice requirements, the manual revision identifies the implementation and effective dates of these instructions as August 26, 2013. Current instructions for the NOMNC are available on the CMS website here.

Section 1869(b)(1)(F) of the Social Security Act grants beneficiaries in Original Medicare the right to an expedited determination process to dispute the end of their Medicare covered care in certain provider settings. Settings include Home Health Agencies (HHA), Comprehensive Outpatient Rehabilitation Services (CORFS), Hospice, and Skilled Nursing Facilities (SNF). This manual update provides expanded guidance for notice requirements and processes.


The manual update starts with more detailed descriptions of exceptions to NOMNC requirements than are available at this time.  Exceptions include instances where no Medicare covered services had been provided, reductions in services, moves to higher levels of care, exhaustion of benefits, beneficiary choice and provider business reasons.

Completion Requirements

Guidance for completing and amending the NOMNC is basically unchanged except for the allowance to include an optional “Additional Information” section and a directive to make the effective date as the last day beneficiaries will receive Medicare coverage for their services. 

Electronic Issuance

Questions about the ability to issue NOMNCs electronically have been raised with the increased frequency with the growth in use of electronic health records (EHR). CMS responded to these questions by allowing the electronic issuance of NOMNCs as well as electronic signatures. However, beneficiaries must be given the option to view the notice in paper format rather than on an electronic screen before signing. Additionally, regardless of how viewed and signed, a paper copy of the NOMNC must be given to the beneficiary at the time of the notice delivery.   The original signed NOMNC must be retained in the beneficiary’s file. If the NOMNC was delivered electronically, the electronic notice retention is permitted.

Delivery of the NOMNC

The instructions allow for delivery of NOMNCs by a delegated agent. However, all delivery requirements must be met, including the requirement to obtain the beneficiary or representative signature and date. Signatures may be by an assistive device.

The delivery timeframe remains at least two calendar days - not 48 hours. Deliveries are not required outside of normal provider operating hours. Exceptions to the two calendar day delivery timeline apply to HHAs. HHAs must deliver notices no later than the next-to-last visit before coverage ends.

Additionally, where a beneficiary is not longer homebound the NOMNC should be immediately delivered upon knowledge of non-homebound status.

Notices may be given earlier than two days before end of coverage as long as the delivery date is tied to an impending end of coverage. Since that is generally not true is given routinely at the start of service notices may only be given at the start of service in short term cases. 

The manual update also includes extensive information about requirements in cases where notices must be delivered to beneficiary representatives.

Appeal to QIO

Finally, the manual addresses procedures related to appeals filed to the Quality Improvement Organization (QIO). These sections reiterate current requirements that providers make available Detailed Explanation of Noncoverage (DENC) and medical records to the beneficiary and the QIO upon notification of an appeal.




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