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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

Legislation Proposes an Episode Cap in Medicare Home Health Services

October 16, 2013 09:05 AM

Last week, legislation was introduced that would limit Medicare payment when a home health agency exceeds certain threshold limits on the average number of episodes of care. The proposed limits would be 2.7 episodes of care in non-rural areas and 3.3 episodes in rural areas. These limits would be applied in the aggregate rather than to individual patients. NAHC opposes this legislative proposal.

The bill, H.R. 3245, was introduced by Congressman Brett Guthrie (R-KY) and Congressman Jim Matheson (D-UT). Both congressman serve on the House Energy and Commerce Committee, which shares jurisdiction over Medicare Part B with the House Ways and Means Committee. Home health care is a benefit under both Medicare Part A and Part B.

Ostensibly, the proposed legislation is intended to be a program integrity measure designed to control fraud, waste and abuse. NAHC shares congressional concerns on program integrity but does not see this legislative idea as a good way to address any such concerns.

An episode cap runs a risk of imposing a barrier to care for chronically ill Medicare beneficiaries who are entitled to unlimited episodes of covered care. If a home health agency ends up with an imbalance of such patients, its episode average rises and may hit the cap. HHAs then face a financial risk if they admit such patients even if those patients fully qualify for Medicare coverage.

NAHC also believes that the cap may trigger a complete change in the Medicare benefit as “safe” patients are limited to those who predictably need only short term care. Over the years, concerns have been raised that the home health benefit was becoming a long term, non-skilled care benefit. That allegation is unfounded as all Medicare home health beneficiaries must meet a rigorous skilled care test for any continued coverage. An episode cap would push the benefit to short term care without actually revising the benefit itself. No business can provide care without reimbursement.

The genesis of the legislative proposal seems to be the periodic reports from the Medicare Payment Advisory Commission that raise concern about the “Top 25 Counties” in terms of service utilization. In those counties, the average level of utilization  finds some home health agencies with over a four episode average per patient. However, there is no evidence beyond the bald statistics that shows any program integrity concerns exist.

NAHC does not believe that HHAs should be presumed guilty of Medicare fraud, waste or abuse as occurs with an inflexible episode cap. Instead, if Medicare has suspicions about the propriety of care utilization, it should target utilization review directly. It may very well be that the HHAs so targeted all provide bona fide, covered services. A claim review is the best way to make that determination. An episode cap is the “nuclear option” at best, to be considered only after all other oversight and enforcement measures have failed.  At this point there is no proof that anything is wrong let alone that targeted corrective measures have failed.

In 2010, NAHC developed and successfully advocated for implementation of a 10% cap on outlier revenues in the Medicare home health benefit. The outlier cap was supported only after enforcement measures failed. Also, the evidence was strong that the affected conduct was abusive as more than 60% of outlier claims came from just one metropolitan area. The HHAs that would be affected by an episode cap are all over the country, albeit in some areas more concentrated than others. This concentration warrants a review, not the premature use of the nuclear option.

The Medicare beneficiary advocacy community shares NAHC’s views on the episode cap proposal. The Leadership Council of Aging Organizations (LCAO) has come out strongly against the concept and is expected to vigorously oppose HR 3245.

NAHC has conveyed its opposition to the bill to its sponsors. Any additional activity involving this proposal will be shared through future NAHC Report articles.




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