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Testimonials

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. 

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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.

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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

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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 element...it’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

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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.

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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.

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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.

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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.

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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.

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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.

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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. 

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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.

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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.

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Frank E. Moss, former U.S. Senator

Anyone working on health care issues in Congress knows the name Val J. Halamandaris.

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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.

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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.

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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.

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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.

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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.

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Former President Bill Clinton

Medicare ALJ Hearings to Experience Significant Delays

January 9, 2014 09:42 AM

The Office of Medicare Hearings and Appeals (OMHA) revealed this week that it is suspending the assignment of most new requests for an Administrative Law Judge (ALJ) hearing because it has “been unable to keep pace with the exponential growth in requests for hearing.“  While OMHA will continue to assign and process hearing requests filed directly by Medicare beneficiaries, it does not expect to resume assignments of other appeals by providers for at least 24 months with post-assignment hearing wait times continuing to exceed 6 months. That means that home health agencies and hospices that file for an ALJ hearing in January 2014 should anticipate that the hearing will be held no sooner than June 2016.

The OMHA explains that the scheduling problems stem from an “exponential growth in requests for hearing.”  Currently there are nearly 357,000 claims that have already been assigned to the 65 ALJs that hear Medicare appeals.  In less than two years, pending appeals rose from 92,000 to over 460,000 with weekly appeal receipts growing from 1,250 to over 15,000. These appeals come from all Medicare benefit sectors, including home health and hospice. The massive increase in appeals is concurrent with the expanded volume of claims reviews and expanded number of Medicare contractors reviewing claims. The MACs, ZPICs, and RACs have all contributed to the number of claim denials that result in appeals. For example, home health agencies have experienced a surge in retroactive claim denials related to the physician face-to-face encounter requirements.

While OMHA explains that it is doing everything possible within its shrunken budget to adjudicate appeals on a timely basis, it essentially admits that it will not be able to comply with the required timeframe for fully processing   ALJ hearing appeals. Federal regulations require that ALJ hearing appeals be completed within 90 days following the date that the request is received by OMHA. However, if that timetable is not met, the only remedy available to an appellant is to accelerate an appeal to the Medicare Appeals Council which then has 180 days to decide the appeal or permit an escalation to the Federal District Court. Such remedies are not considered to be of any great value.

By and large, the action of OMHA is one salvo in the annual battle over funding and resource allocation with the Department of Health and Human Services. However, this time the consequences to health care providers is significant as the volume of contested claim denials continues to grow dramatically. If Medicare continues to ramp-up claims reviews, it should expect to do the same to the resources committed to appeals, especially at the ALJ level where providers find the fairest and most complete level of review. In addition, HHS should evaluate the quality and accuracy of the claim determinations as a way of potentially reducing appeal workload. ALJ reviews have consistently led to high rates of reversals of claim denials. If the initial claim review quality is enhanced, the demand on the appeals system for corrective actions should be significantly reduced.

In addition to the delays that are occurring with the ALJ appeals, Medicare providers are impacted by the recoupment of any alleged overpayments. Under Medicare law, there is no recovery of an overpayment through the first two stages of an appeal. Following an unsuccessful “reconsideration” appeal to the QIC, a provider will face a payment recovery even if an appeal is filed with an ALJ. With an expected 30-month period for current ALJ appeals, providers face an extended period of financial losses.

NAHC is evaluating what the next best action steps should be employed to address this growing problem. No quick solutions are expected. In the meantime, NAHC recommends that HHAs and hospices continue to pursue ALJ appeals whenever they deem appropriate, but they should factor in the financial implications in their own operations that account for the delay in the appeal resolution.

 

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