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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

California Bill Seeks to Increase Home Care Regulation

September 18, 2013 03:55 PM

The California legislature continues to work out language for the Home Care Services Consumer Protection Act (A.B. 1217), which would increase regulation for home care organizations and home care aides.  If enacted, the legislative change would affect both Medicaid and non-Medicaid home care services. The National Council on Medicaid Home Care – a NAHC Affiliate discusses the most pertinent provisions.


Currently, California requires certification of home health aides and background checks are required for In-Home Supportive Services workers.  California requires licensure of its home health agencies, and 93 percent of them are also certified by either CMS or other organizations like the Joint Commission. 

However, providers of non-skilled home care services are not as regulated.  In California, there are currently no licensing requirements for agencies or individuals providing home care aide (HCA) services, i.e. those that provide care not related to health, such as cooking, homemaking, or shopping.  Currently, 24 other states requiring licensure of these types of home care organizations (HCOs).

To see more information on the current status of regulation, click here for an article, and here for a recent UCLA study.   

General Provisions

Summary. A.B. 1217 requires: 1) the licensure and regulation of HCOs, and 2) the registration of HCAs.  The bill excludes certain entities from the definition of HCOs, as well as certain individuals from the definition of HCAs.

Exclusions.  HCOs do not include home health agencies, hospices, or a county providing in-home supportive services.  Similarly, HCAs do not include those providing home care services through a licensed home health agency, a licensed hospice, or via in-home supportive services (IHSS). 

HCO Provisions

Licensure of HCOs.  If the owner of the HCO is an individual or individuals, the owner must submit a valid identification card and consent to a background examination.  If the owner is a corporation, association, joint venture, limited liability company, or another entity, an individual with at least a 10 percent interest must consent to a background examination.

Unauthorized Representation and Provision of Care.  A person or organization cannot represent themselves as being an HCO or providing home care until they have been licensed.  Provision of home care services prior to licensure is deemed “unlicensed home care services,” subject to civil monetary penalties and cease and desist orders. 

Renewal.  Once registered, an HCO must renew his or her registration every two years.  This is contingent on submitting a renewal application form and paying renewal fees prior to the license’s expiration.  Further, a renewal is contingent on the HCO “continuing to satisfy the requirements set forth in this chapter, and cooperating with the department in the completion of the home care organization licenses renewal process.”

Operating Requirements.  The HCO is required to do several things, including: posting its license, abiding by worker’s compensation laws, maintaining an employee dishonesty bond, and reporting suspected or known adult abuse.

Operating Requirements Regarding HCAs: The HCOs must ensure that its employed HCAs are properly registered before allowing them to have direct contact with patients.  Also, the HCOs must ensure that all employees, staff, or volunteer interacting with clients, prospective clients, or confidential client information has met the requirements of obtaining a background clearance as required in this bill.  HCOs must also ensure that their HCAs have completed the required training as specified in this bill.  Also, HCOs are required to have their HCAs demonstrate they are free from active tuberculosis, and to keep this certificate on file.  Finally, HCOs must notify the State Department of Social Services immediately when the HCO no longer employs one of its HCAs.

HCA Provisions

HCA Registry. A.B. 1217 mandates the establishment of a HCA registry, which would provide specific information on both registered HCAs and HCA applicants. 

Background Clearances.  HCAs must undergo background clearances, including a signed declaration regarding any prior criminal convictions, as well as a declaration that they are free of active tuberculosis.

Registry and Exemptions.  Those individuals not employed by an HCO may be listed on the registry if they provide home care services.  HCAs employed by an HCO to provide home care services shall be listed on the registry before they can provide home care services to a client.

Renewal.  Once registered, an HCA must renew his or her registration every two years to stay registered.

To see A.B. 1217, click here

The Council’s Take

The Council supports minimum standards for home care agencies, licensing being one such standard, but opposes standards that are overly burdensome.  The Council therefore supports more balanced bills like A.B. 322, of which the California Association for Health Services at Home (CAHSAH) is a sponsor, and also joins CAHSAH in opposing A.B. 1217. 

A.B. 322, in establishing minimum licensure requirements for private home care agencies providing non-medical care in the home, balances oversight and consumer protection concerns.  To see CAHSAH’s position on A.B. 322, click here.  To see A.B. 322 itself, click here.

Some home care providers have expressed concerns that the licensure requirements of A.B. 1217 will drive up prices.  As Nadereh Pourat, the director of research at the UCLA Center for Health Policy Research stated: “[t]he concerns have validity.  Licensure can impact price.  You’re asking people for additional paperwork and effort.”  For her full comments on the legislation, click here.  CAHSAH echoed cost concerns as well.  CAHSAH stated in its 2013 Legislative Priorities that “[t]he provisions regulating the use of home care aides in A.B. 1217 are burdensome and will increase the cost of services purchased by working and middle class families.  As the cost of care increases, families will be forced to make tough decisions in order to receive care.” For a link to CAHSAH’s 2013 Legislative Priorities, click here.  In fact, in a one-pager on A.B. 1217, CAHSAH maintained that home care agencies will bear the entire cost of licensure.  The Council echoes these concerns and stands with CAHSAH in its opposition to this bill.

Home care companies should anticipate future regulatory and legislative action to regulate home care, especially in the states that currently do not require licensure of HCOs and/or HCAs.   A movement is also afoot to require background checks for caregivers. 

As regulators react to fraud and abuse, believing that all problems can be solved through another layer of rules, stakeholders should remain actively engaged in these processes through the forums or state advocacy.  To the extent that there is a need for reforms, it is important to craft sound legislation/regulation that protects patients while putting the fewest restrictions on honest caregivers.  Home care companies are encouraged to keep abreast of home care legislative and regulatory initiatives in their states, and to contact the Council with any questions or concerns.




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