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National Association for Home Care & Hospice
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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

MedPAC Gives Initial Approval to Freeze FY2015 Hospice Payments - Inclusion of Hospice Under Medicare Advantage

Final Consideration will be Given at January Meeting
December 19, 2013 04:24 PM

At its December meeting, the Medicare Payment Advisory Commission (MedPAC) gave preliminary approval to inclusion of two recommendations directly related to hospice as part of its anticipated March 2014 report to Congress:

  • Inclusion of hospice as part of the benefits package under private Medicare Advantage (MA) plans (see NAHC Report, Nov. 19, 2013); and
  • A zero market basket update for fiscal year (FY) 2015 payments.

MedPAC chair Glenn Hackbarth noted that the Commission's zero update recommendation presumed no imposition of the 2 percent sequester. MedPAC hasn’t incorporated the sequester as a factor when it develops recommendations because it had been seen as a “temporary” measure on which Congress would likely take action. 

Since it appears that the sequester may remain in place for the foreseeable future, MedPAC will likely include the impact of the sequester as a factor in developing its recommendations next year.

The Commission believes that hospice should be included under the MA benefit package to ensure that beneficiaries have seamless access to all Medicare benefits regardless of whether they are enrolled in traditional Medicare, a MA plan, or receive their care through an accountable care organization. 

If MA plans are required to offer hospice services, they will maintain responsibility for all costs of care at the end of life.  Under the recommendation MA plans would receive an increase in their capitated payments to cover the cost of hospice care. Med PAC envisions a structure under which, in most cases, MA plans would contract with Medicare-certified hospices to provide care.  At this time it appears that MedPAC would recommend that this change be effective in 2017, the year in which MA capitated payments will be equivalent to per capita payments under Medicare FFS, as the change at that time would have limited budgetary impact (an earlier transition would increase projected overall Medicare expenditures).

As part of its analysis related to the financial status of hospice programs, MedPAC supplied data related to the Medicare hospice program for 2012:

  • 1.27 million individuals were enrolled in hospice
  • Hospice cared for nearly 47 percent (46.7) of Medicare decedents
  • Medicare-certified hospices numbered more than 3,700
  • $15.1 billion in payments were expended for hospice
  • About $1 billion in Medicare payments were made to non-hospice providers for care unrelated to the terminal condition (payments from a combination of Parts A, B, and D)
  • Average length of stay was 88 days (up from 86 days in 2011)
  • Median length of stay was 18 days (up from 17 days in 2011)
  • Length of stay varied by diagnosis, patient location, ownership and type of hospice; the length of stay for the longest staying patients continued to increase
  • The average hospice Medicare margin in 2011 was 8.7 percent (up from 7.4 percent in 2010); if bereavement and volunteer costs were allowable, overall average margins would go down by 1.7 percent. However, if MedPAC adjusted payments for facility-based hospices to exclude the allocation of overhead from the parent, an additional 1.9 percentage points would be added back to the average margin.

MedPAC estimates that average hospice margins in 2014 will be approximately 7.8 percent, which includes market basket reductions mandated by the Affordable Care Act and the further phase out of the budget neutrality adjustment factor.  The estimated margin also includes additional costs due to cost growth and increased regulatory requirements.

In recent discussions with MedPAC, NAHC’s Hospice Association of America (HAA) has expressed serious concerns about inclusion of hospice under the MA benefit package and its impact on beneficiary choice, the hospice benefit package, and the future of the hospice program. 

The presentation slides used by MedPAC staff to guide discussion on the hospice recommendations are available online at the following locations:  Medicare Advantage and Hospice Payment Update

Additionally, at some point in the near future the transcript from the session should be posted on MedPAC’s website here.   





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