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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

Heath 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

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

MedPAC Ponders Hospice Coverage under Medicare Advantage

November 19, 2013 03:23 PM

At its most recent meeting - held November 7-8 - the Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare payment policy, discussed ways to ensure better synchronization across Medicare delivery systems, including fee-for-service (FFS), Medicare Advantage (MA), and Accountable Care Organizations (ACOs).  During the meeting, MedPAC staff sought the Commissioners’ guidance on whether to conduct additional study on the advisability of including hospice services as part of MA plans’ benefit package.  Members of the Commission expressed support for the concept of eliminating this “fragmentation”, and it is anticipated that they will discuss the issue further at a forthcoming meeting in December or January.

Since its start as a benefit under Medicare, hospice has been available exclusively as a FFS benefit.  It is believed that the reasoning for exclusion of hospice from coverage by private plans under Medicare is due to the fact that there was insufficient data on hospice costs to establish an add-on to private plan rates for hospice care.  Instead, MA enrollees who choose to elect hospice care historically have been referred to a hospice provider that is paid under the Medicare FFS program.  While on hospice care the patient continues to pay MA premiums and retains coverage of supplemental benefits and Part D, if enrolled, for non-hospice prescriptions, but is covered under the FFS program for standard Medicare benefits under Part A or Part B in addition to hospice services. If a MA beneficiary is nearing the end of life but chooses not to elect hospice, the MA plan is responsible for care. 

MedPAC views the coverage structure as confusing for beneficiaries and contrary to the goal of consistency in policy, regardless of the delivery structure under which the beneficiary receives care.  MedPAC staff used the following graph as part of their presentation to illustrate the fragmentation of coverage rules for Medicare beneficiaries enrolled in MA-PD plans:





Prior to hospice enrollment


• All part A, B, and D services, and any supplemental benefits

MA-PD enrollee elects hospice

• Hospice

• Part A and B services unrelated to the terminal condition

• Part D drugs unrelated to terminal condition

• Any supplemental benefits (e.g., reduced cost-sharing)

MA-PD enrollee disenrolls from hospice


• Until the end of the month, all PartA and B services

• All Part D drugs

• Any supplemental benefits (e.g., reduced cost sharing)

• Beginning the next month after disenrollment, Part A and B services


MedPAC staff suggested that “broadening the package of services that MA plans are responsible for to include the full continuum of end-of-life care may promote care coordination and incentivize plans to focus more on efforts to improve quality, efficiency, and satisfaction with care for patients with advanced illnesses.  It’s also possible that some plans may choose to experiment with covering concurrent hospice and curative care…” 

Staff also acknowledged that including hospice coverage under MA could mean that beneficiaries have fewer choices among hospices since MA plans would likely contract with a smaller number of hospice providers than are available in a particular market.  Given that under the current payment structure MA plan are still paid at a higher percentage than the cost of care under FFS Medicare, MedPAC staff suggested that bringing hospice under the MA benefit may be most appropriate in 2017, at which time the Affordable Care Act (ACA) requires payments under FFS and MA payments to equalize. 

A transcript of the entire meeting is available here. The MA/hospice discussion takes place on pp. 332-382. 

The National Association for Home Care & Hospice (NAHC) and its affiliated Hospice Association of America (HAA) will be closely engaged on this and other important hospice issues, and will provide updates in future issues of NAHC Report and Hospice Notes.




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