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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

NAHC’s Analysis of the 2014 HHPPS Rate Rule

November 26, 2013 04:27 PM

The Centers for Medicare and Medicaid Services (CMS) published the long-awaited Final Rule that sets out the 2014 Medicare home health payment rates. The Final Rule represents an overall modest improvement over the proposed rule that was issued in late June. The improvements are due to a combination of changes including modification of the case mix weight recalibrations, updated visit utilization data, and a modification in the calculation of the 3.5 percent annual rebasing adjustment cap. Overall, the base episode rate increases by $9.07 per episode, case mix weights increase by an average of .39 percent, and LUPA rates and Non-routine supplies (NRS) payment decrease slightly from the proposed rule.

CMS rejected the industry’s call for alternative rebasing methodologies, recognition of already decreasing Medicare margins, and the need for operating capital.

CMS estimates that the Final Rule reduces Medicare payments by 1.05 percent or $200 million, in contrast to the 1.5 percent reduction it estimated with the proposed rule. However, the real reduction is greater because CMS includes the 2.3 percent increase coming from the annual inflation update, an increase intended to cover increased costs of care. The actual effective cuts are $520 million from rate rebasing and $120 million from HHPPS grouper refinements.

As noted, all of the below rates include the annual inflation update (Market Basket Index) of 2.3 percent. The final MBI is down from the proposed 2.4 percent because of updated data available for use in forecasting 2014 cost inflation.

This article provides a detailed overview of the rate rule. NAHC will follow with analysis on the other changes in the rule that affect HHRG scoring through the elimination of 170 ICD-9 in the case mix adjustment model and other process modifications that CMS finalized.

As with the proposed rule, the final 2014 rate rule must be understood as the sum of two significant changes. First, CMS rebased all elements of the prospective payment system: base episode rates; LUPA per visit rates; and the NRS conversion factor that directly affects payments. Second, CMS recalibrated all of the case mix weight categories in the HHRG grouper, resetting them to the average weight of 1.0.

As a result, while the base episode rate appears much higher than the 2013 rate, when combined with the reduced, recalibrated case mix weights, the 2014 payments will be lower in 2014 than in 2013.


2013:  $2,137.73

Proposed 2014:  $2,860.20

Final  2014$2,869.27


To understand the actual negative impact of the rebasing, it is necessary to apply the HHRG group. For example, Grouper code 30321, C3F2S1, has a multiplier of 1.1054. In 2013, that would lead to a payment of $2363.05 - before wage index impact.

The 2014 multiplier is .8210. With the rebased episode rate of $2,869.27, the episode payment will be $2,355.67 or $7.38 less.

The final 2014 rate is a slight improvement over the proposed rate. In the CMS proposal, a C3F2S! Episode had a case mix weight of .8178 and a lower base rate of $2860.20. That combination would have resulted in a payment of $2,339.07 or $16.60 less than the final rule level.

The difference in the final episode rate is due to revised data on the number of visits in the average episode that CMS used to calculate average episode costs. In addition, CMS revised its calculation of the average episode payment. Finally, CMS applied the 3.5 percent rebasing adjustment consistent with statutory requirements that it be based on 2010 rates.




Payment per episode EST 2013



Cost per episode EST 2013






Phase-in rebasing cut




LUPA per visit rates are unaffected by the grouper recalibration. However, the LUPA rates are negatively impacted by the 3.5 percent cap as data shows that per visit costs are more than 3.5percent greater than the 2013 rates. The LUPA rates are further impacted in a negative way by the requirement that the cap is based on the 2010 rates.

As such, the final LUPA rates are lower than the proposed rates.

LUPA rates


Proposed 2014

Final 2014


Skilled Nursing





Home Health Aide





Physical Therapy





Occupational Therapy





Speech- Language Pathology





Medical Social Services         






Non-routine supplies (NRS) payments will be lower in 2014. The CMS analysis for the final rule shows a reduction of 2.82 percent, an increase from the proposed 2.58percent reduction due updated data. The four year rebasing reduction increases from 9.92 percent to 11.28 percent.

Non-Routine Supplies




Conversion factor




Rebasing change




Severity Level



























CMS makes no changes in the outlier episode qualification standards. The Fixed Dollar Loss (FDL) remains at 0.45, the level set in 2013.

The Loss Ratio also remains at .80. The FDL and the Loss Ratio are used to determine when an episode qualifies for additional outlier payment and the amount of that payment. CMS estimates that only 2.07 of the 2.5 percent outlier budget will be expended with these standards.

If CMS forecasting is accurate, the result will be that home health agencies are deprived of $78 million in outlier funding.

NAHC will continue its advocacy efforts to correct and further improve CMS’s rate rebasing standards and methodology, which fails to fully account for all costs of care and ignores the essential need for working capital.

During the regulatory campaign, NAHC secured significant, bipartisan support from Senators and members of the House of Representatives. We will be calling on those allies again to reverse the CMS rule.

The Final Rule can be accessed at here.  

NAHC will report on any and all developments in future issues of NAHC Report.




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