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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

Part D Payment for Drugs for Beneficiaries Enrolled in Hospice — Request for Comments

December 10, 2013 09:51 AM

As reported in the November 5, 2013 and October 24, 2013 NAHC Report, there are two issues of ongoing concern that are related to hospices and Part D drug payment:

  1. recoupment directly from hospices of payment for analgesics made by Part D plans in 2011 and 2012 while the beneficiary was enrolled in hospice, and
  2. approval of Part D payment for medications for current hospice beneficiaries

The Centers for Medicare & Medicaid Services (CMS) released a memo on December 6, 2013 addressing the second issue, citing a belief that CMS policy statements are possibly being misinterpreted.  The National Association for Home Care & Hospice (NAHC) and its affiliated Hospice Association of America (HAA), along with other hospice advocates, communicated such concerns to CMS.  The memo is addressed to all Part D plan sponsors and Medicare hospice providers and contains clarification on determining responsibility for payment of medications by Part D plans while a beneficiary is enrolled in hospice.  There are new expectations based on these clarifications for Part D sponsors to prevent duplicate payments for drugs covered under the hospice benefit or waived through the beneficiary’s hospice election.  Specifically, CMS directs Part D Plan sponsors to place beneficiary-level prior authorization (PA) requirements on all drugs for hospice beneficiaries to determine whether the drugs are coverable under Part D or should be the responsibility of the hospice.

The memo provides a detailed summary and history of hospice payment responsibility and processes surrounding that as well as previous Part D guidance. It is longstanding CMS policy that hospices cover all services that are reasonable and necessary for the palliation and management of the terminal illness and related conditions.  Decisions regarding services that are unrelated to hospice care or not reasonable and necessary for the palliation and management of the terminal illness and related conditions are made on a case-by-case basis.

CMS continues to be concerned that drugs covered under the Part A Hospice Benefit are being billed to Part D inappropriately. Part D plans are not to be paying for medications that should be covered under Medicare Part A and specifically the Medicare hospice benefit.  Medicare hospice patients can receive drugs that are related to the terminal illness and related conditions but not reasonable and necessary for the palliation and management of symptoms.  This would include such drugs as those determined by the hospice interdisciplinary group to not be effective or for which there is an equivalent drug on the hospice formulary but the patient refuses this drug. The expectation is that if patients choose to receive such drugs, the patient is responsible for payment. The memo also restates CMS’ general view that hospices are required to provide virtually all the care that is needed by terminally ill individuals.

Therefore, CMS’ conclusion is that only under rare circumstances would a drug prescribed for a hospice patient be  completely unrelated to the patient’s terminal illness or a  related conditions.  However, since it is possible for this to be the case, CMS indicates that a PA process allows for such a consideration.  The memo clearly states CMS expects the hospice provider to coordinate with the plan sponsor regarding these claims and provide the necessary written information, as requested by the sponsor. The memo stated that CMS will be posting hospice contact information on the CMS website which Part D plan sponsors will be able to access for their communication needs.

The PA process is not specified in the memo, which would allow each Part D plan sponsor to develop its own PA process.  The memo goes on to state that CMS recognizes a mechanism is necessary for handling disputes between the hospice and Part D sponsors regarding payment responsibility when the drug should be paid for and the question at issue is whether it should be paid for by the hospice or Part D sponsor. As a result, CMS is exploring incorporating an independent reviewer function as part of the appeals process under a CMS contract. The independent reviewer’s decisions will be binding on the hospice and the Part D sponsor. Details of the independent review process are expected to be outlined in future guidance providing adequate notice to all affected parties.

In the interim, CMS expects:

  • The hospice and Part D sponsor to coordinate their benefits;
  • The hospice/prescriber to immediately provide written documentation to satisfy the PartD PA;
  • The Part D sponsor to accept and maintain the documentation that the drug is unrelatedand not waived through the hospice election and is, therefore, reimbursable under Part Dand process the claim; and
  • If the sponsor disagrees with the hospice/prescriber decision, the sponsor should flag the claimand request a retrospective determination of drug payment responsibility by the independent reviewer once the process is implemented.

This process is dependent on the hospice entering the Notice of Election (NOE) in the CMS system as soon as possible after the patient elects the hospice benefit in order for the Part D sponsor to be able to access the information about hospice elections.  There is guidance to Part D sponsors in the memo regarding how they should process drug information for hospice beneficiaries.  If, after the Part D plan approves a drug, it is determined that the hospice or the beneficiary is responsible for payment CMS expects Part D plan sponsors to implement processes to handle payment resolution directly with hospices and beneficiaries without having the pharmacy reverse and rebill the original claim.

The effective date of this policy clarification will be March 1, 2014. Part D sponsors, however, must follow prior CMS instructions concerning the denial of Part D payments for analgesics for hospice beneficiaries (see NAHC Report, November 15, 2013).

Comments on the clarification are due to CMS by noon EST on January 6, 2014.  NAHC and HAA are compiling comments for submission.  Please send comments to or

Below are some items for hospices to consider as they review this memo and tips for hospice processes related to hospice and Part D drugs:

  • If the hospice is not already utilizing a formulary, it should consider implementing one.
  • Hospices should ask patients at admission if they are enrolled in a Part D plan, and if so, which one.  Hospices can find the list of 2014 Part D Plans here.
  • Hospices should begin planning communication strategies with the Part D plans in their service area should this clarification be finalized as written.
  • Implement or reinforce processes for medication review on each regularly scheduled hospice visit to ensure the hospice is aware of all medications the patient is taking.  This is particularly important for patients residing in facilities.
  • Implement or reinforce processes for identifying related and non-related medications and communicating this information to the pharmacy and the patient/family.
  • Conduct routine audits to ensure documentation supporting non-related medications is clear and present in the medical record.
  • Conduct routine audits to ensure the pharmacy is billing hospice for ALL related medications.
  • Will there be an increase in beneficiary appeals due to this process?



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