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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 Approves 2015 Recommendations on Home Health Services

January 21, 2014 09:56 AM

The Medicare Payment Advisory Commission met on January 16 and 17 to consider and vote on its recommendations to Congress for 2015 payment rate changes and other reforms. Annually, MedPAC issues its “March Report” to Congress setting out a wide range of recommendation predominately focused on payment rates for all Medicare provider sectors. In addition, these reports often present recommendations on broader system reforms.

This year the Commission decided to maintain last year’s home health recommendations on payment related matters and to add a new one on penalties for providers that show a high degree of avoidable readmissions to hospitals. The left-over payment recommendations include:

  • A zero inflation update (Market Basket Index/MBI)
  • Accelerate rate rebasing from a 4 year phase-in to a shorter period, e.g. 2 years
  • Reduce reimbursement for therapy episodes
  • Institute a copay for patients that are not admitted from inpatient care
  • Expand fraud and abuse efforts to address regions with aberrant patterns of utilization

The commissioners did not vote on the leftover recommendations, choosing instead to merely agree that they would continue them for another year.  The primary reason for the continued recommendations on payment rates is MedPAC’s calculation that the Medicare margin for home health agencies in 2012 was 14.4 percent. MedPAC’s calculation excludes all hospital-based HHAs.

NAHC’s analysis of all 2012 cost reports shows a slightly - but materially different -Medicare margin of 13.02% for freestanding HHAs and 10.14% for all HHAs. What is significant about the difference is the margin trend that it displays. Over recent years, Medicare margins for freestanding and hospital-based HHAs have been dropping at a level just under the level of rate cut triggered by legislative or regulatory action.

The reductions in Medicare margins means that MedPAC’s forecast on the impact of rate cuts and rate rebasing understanding the financial fragility of home health agencies. MedPAC predicts that HHA Medicare margins in 2014 will be 12.6% despite the 1 point MBI and 1.32 point case mix creep cuts in 2013 and the near 3.5 point cut in 2014, the first year of rebasing.   Under MedPAC’s approach, that means that it forecasts that 7.82 points in cuts in 2013 and 2014 only reduce margins by 1.8 points. NAHC’s projection is a margin of approximately 5% for freestanding HHAs in 2015.

The margin forecasting is crucial to proper payment rate decisions. NAHC continues to counter the MedPAC assertions in discussions with Congress, using its data on nearly 10,000 HHAs and its analysis of margin trends to show that rebasing cuts need to be rolled back rather than deepened.

The MedPAC recommendation on copays borrows from the President’s budget to an extent. That budget and the MedPAC recommendation focus on copay on episodes of care that are not preceded by an inpatient hospital stay. NAHC sees such a proposal as the least sensible copay concept in that it would encourage patients to seek high cots hospital care to avoid home health copay. Instead, Medicare should encourage early use of home health services to avoid both initial hospitalizations and readmissions.

The newest MedPAC recommendations affecting home health services are:

  • Establish a hospital readmission reduction policy through a penalty payment for abnormal rehospitalizations rates
  • Devise a patient assessment instrument that can be commonly used across post-acute care (PAC) settings

The PAC patient assessment instrument recommendation is one that NAHC has long supported. In the recent past, Medicare tested a NAHC-supported CARE tool for assessing all patients in PAC.

The MedPAC recommendation on a hospital readmission policy has qualified support from NAHC. The MedPAC recommendation appears to focus on penalizing HHAs that show high rates of avoidable rehospitalizations. NAHC instead supports a policy that combines rewards with penalties, recognizing that incentivizing high performance in HHAs is a positive way to achieve success. In addition, such a value-based reimbursement system requires a reliable risk adjuster and a precise standard for determining “avoidable” rehospitalizations to operate fairly. NAHC has conveyed to MedPAC that important work needs to e done on those two matters prior to implementing any penalty/reward program.

The MedPAC recommendations, both the new and rerun ones, will be included in a report to Congress that will be submitted by MedPAC in early March. With the flurry of activity on the physician SGR legislation expected this year, the recommendations are likely to take on a special weight in Congress’ search for ways to pay for the physician rate reform. This means that the home health care industry needs to remain highly engaged or face the risk of unfavorable policy actions.

NAHC encourages all of its members to join in this year’s March on Washington March 23 – 26. Please click here for more information.




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