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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 Year in Review: Regulatory Policy and Issues

January 3, 2014 08:01 AM

2013 was an eventful and busy year within the regulatory area for home care and hospice providers. Below are the most significant developments for the home care and hospice community with respect to regulatory policy and issues compiled by NAHC Regulatory staff:

Face-to-Face Encounters in the Home Health Prospective Payment System Rate Update for Calendar Year 2013  

The Centers for Medicare & Medicaid Services (CMS) provided additional regulatory flexibility regarding face-to-face (F2F) encounter requirements, including:

  • Allow facility-based NPP to perform encounter
  • Allow the NPP who is collaborating with or under the supervision of the certifying physician to communicate the findings with the certifying physician (i.e. inpatient or community)
  • Allow the facility-based physician to complete the F2F and either certify or communicate findings to the certifying physician in the community  
  • Allow any party to title and date F2F documentation

Alternate Sanctions

The Home Health Prospective Payment System Rate Update for Calendar Year 2013 contained provisions to implement alternate sanctions if HHAs were out of compliance with Federal requirements. The sanctions apply to condition level deficiencies in lieu of termination.

The basis for choice of sanctions will be based on:

  • The extent to which the deficiencies pose immediate jeopardy
  • The nature, incidence, manner, degree, and duration of the deficiency
  • The presence of repeat deficiencies and compliance history.
  • The extent to which the deficiencies are related to failure to provide quality care.
  • The extent to which the HHA is part of a larger organization with performance problems.

The following sanctions are effective July 1, 2013:

  • Directed plan of correction
  • CMS directs the HHA on specific actions and outcomes to achieve within specific time frames
  • Directed in-service training
  • HHA training by a CMS or stated approved entity
  • Agency responsible for all associated costs  
  • Temporary management
  • CMS approved entity
  • Agency responsible for all associated costs

The following sanctions are effective July 1, 2014 :

  • Civil money penalties
  • Suspension of payment for new admissions
  • Informal dispute resolution

HIPAA Final Rule
The Department of Health & Human Services (HHS) issued a long-awaited HIPAA final rule which is entitled: Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules Under the Health Information Technology for Economic and Clinical Health Act and the Genetic Information Nondiscrimination Act; Other Modifications to the HIPAA Rules; Final Rule.

The 2013 HIPAA Final Rule includes the following provisions on interest to home care and hospice providers:

  • Expands the definition of business associate to include subcontractors
  • Clarifies direct liability of business associates, and limits covered entity liability
  • Requires business associate disclosures to Secretary, and to the individual
  • Breach evaluation is now more standardized
  • Requires individual authorization for marketing
  • PHI of Decedents
  • Expands notice of privacy requirements
  • Addresses individuals rights to limit use of PHI,  as well as access to PHI
  • Effective September 23, 2013, a new one year transition period for static contracts is implemented

Revised OSHA Standards

The U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) has revised its Hazard Communication Standard (HCS), aligning it with the Globally Harmonized System of Classification and Labeling of Chemicals (GHS). The revised HCS will be fully implemented in 2016 and benefit workers by reducing confusion about chemical hazards in the workplace, facilitating safety training, and improving understanding of hazards, especially for low literacy workers.

OSHA's standard will classify chemicals according to their health and physical hazards, and establish consistent labels and safety data sheets (SDSs) for all chemicals made in the United States and imported from abroad.

Further information for workers, employers and users of hazardous chemicals can be reviewed at OSHA's Hazard Communication Safety and Health topics here, which includes links to OSHA's revised Hazard Communication Standard and guidance materials such as Q&A's, OSHA fact sheets, and Quick Cards.

Additional Claims Data
Effective for home health episodes beginning on or after July 1, 2013, HHAs are to use the following HCPCS codes:

  • Q5001: Hospice or home health care provided in patient’s home/residence
  • Q5002: Hospice or home health care provided in assisted living facility, or Q5009: Hospice or home health care provided in place not otherwise specified on home health claims to report where home health services were provided.

To view Change Request 8136, which included the additional claims data, please click here.


CMS Announced PECOS Activation for January 6, 2014. CMS announced the full implementation of the Provider Enrollment, Chain and Ownership System (PECOS) edits on ordering/referring providers in Medicare Part B, DME, and Part A home health agency (HHA) claims.

CMS will turn on the Phase 2 denial edits beginning January 6, 2014. This means that Medicare will deny claims for services or supplies that require an ordering/referring provider to be identified - and that provider is not identified, is not in Medicare's enrollment records, or is not of a specialty type that may order/refer the service/item being billed.

To view the Medlearn Matters article, please click here.

Home Health Advanced Beneficiary Notice

CMS has released Change Requests 8403 and 8404 that announce changes to the Home Health Advanced Beneficiary Notice (HHABN) and instructs agencies on the use of the Advanced Beneficiary Notice (ABN) and the Home Health Change of Care Notice (HHCCN).
In their effort to “streamline, reduce, and simplify notices,” the CMS has eliminated the HHABN. The liability format of the HHABN (Option Box 1) will be replaced with the existing ABN, the form currently used by other Medicare providers to notify beneficiaries of Medicare non-coverage as required by the Social Security Act.

The HHCCN – a new form – has been created to notify beneficiaries of reductions in service for other reasons as required by the Lutwin v. Thompson decision. The HHCCN will replace both Option Box 2 and Option Box 3 formats of the HHABN.

Agencies may begin using the ABN and HHCCN now, but must use these forms to notify Medicare beneficiaries of any financial liability and /or changes in care beginning December 9, 2013. For items and services provided on or after December 9, 2013, the HHABN will no longer be valid.
To view the revised forms and instructions, please click here.

Confined to the Home

CMS released Change Request (CR) 8444 that clarifies the definition of “confined to the home” for

Medicare-covered home health services.

In the 2012 Home Health Prospective Payment System (HHPPS) rule, CMS finalized clarifications to the Benefit Policy Manual language regarding the definition for "confined to the home.” CMS claims they clarified the definition in response to the Office of Inspector General (OIG) recommendations and to more accurately reflect the definition as written in the Social Security Act.

The CR also removes vague terms such as “generally speaking”. 

In order for a patient to be considered confined to the home, both the following criteria must be met:
The individual has a condition due to an illness or injury that restricts his or her ability to leave their place of residence except with the aid of supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person; or if leaving home is medically contraindicated.

The condition of the patient should be such that there exists a normal inability to leave home and, consequently, leaving home would require a considerable and taxing effort.

To view Change request 8444, please  click here.

Jimmo Guidance

CMS issued manual guidance related to the Jimmo v. Sebelius lawsuit decision. The lawsuit puts an end to the Medicare contractors applying an improvement standard for Medicare covered services. CMS has consistently stated that the decision does not alter the Medicare benefit in any way, but serves to clarify that coverage of skilled nursing and therapy services does not require that  the beneficiary have a  potential for improvement, but rather that the beneficiary is in need of skilled care.
Relative portions of the manuals for Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), Home Health (HH), and Outpatient (OPT) coverage have been updated.
To view Change Request 8458, please  click here.

HIPPS Codes on MA Claims

The Centers for Medicare & Medicaid Services (CMS) once again delayed the edit to reject Medicare Advantage (MA) plan claims that do not have a health insurance prospective payment system (HIPPS) code for home health services. The edits will not be activated until July 1, 2014.

MA plans and HHAs have until that time to make the necessary system adjustments.

CMS initially intended to require that MA plans include a HIPPS code on all home health encounters beginning July 1, 2013. The National Association for Home Care & Hospice (NAHC) contacted CMS in June to discuss concerns regarding the failure of the health plans to communicate this directive with the provider community. Several weeks after NAHC’s call to CMS, CMS announced that were delaying the edit until December 1, 2013.

Discontinuation of Home Health Type of Bill 33X

The 033X Type of Bill will no longer be used. The 032X Type of Bill has been redefined to mean "Home Health Services under a Plan of Treatment." This Change Request defines the changes needed for Medicare systems to implement these revisions and updates the home health chapter of Pub. 100-04, Medicare Claims Processing Manual to reflect the new definitions.
To view Change Request 8244, please  click here.




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