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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

Heath 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

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

CMS Approves KanCare Carve-In of ID/DD Population

February 7, 2014 02:33 PM

On January 29, the Centers for Medicare and Medicaid Services (CMS) approved Kansas’ inclusion of the Intellectually Disabled/Developmentally Disabled (ID/DD) population into its Medicaid managed care program KanCare, effective February 1.  In a letter to the Medical Director of the Kansas Department of Health and Environment (KDHE), Cindy Mann, the Director of the  Center for Medicaid and CHIP Services (CMCS) of the Centers for Medicare and Medicaid Services (CMS), attached a 106-page document highlighting the Special Terms and Conditions (STCs) stipulating the details.  The Council reports on some of the key STCs as they apply to the ID/DD population.

Scope of the Carve-In

Services. Services in the carve-in include targeted case management and HCBS services, including: assistive services, financial management services, medical-alert rental, overnight respite, personal assistance services, residential and day supports, sleep-cycle supports, specialized medical care, supportive employment, supportive home care and wellness monitoring. For details, clickhere.

Transition period. During the transition period from fee-for-service (FFS) to managed care, ID/DD enrollees can see their old long-term services and supports (LTSS) providers for 180 days from February 1, or until a service plan is in place.  Those with residential LTSS providers can continue to see them for as long as oneyear, at full FFS rates.  After the transition, out-of-network qualified providers are reimbursed at 90% of in-network providers.  For details, see page 27 and 36, here.

Obligations of the Plans

Network adequacy. Each MCO must contract with at least two ID/DD LTSS providers in every county where at least two providers are available, licensed and certified. Each MCO must extend three contract offers to each provider serving the ID/DD enrollees for at least the FFS rate.

Obligations of the State

Protections from improper institutionalization.  The State must review and approve all recommendations of placements into ICF/IID or nursing facilities, in order to prevent any improper institutionalizations.

Elimination of the underserved waitlist.  In January, the State had expressly declared that it will seek to eliminate the so-called “underserved waitlist” “over the next several months.”  The waitlist includes approximately 1,400 developmentally disabled Kansans who are only receiving some of the Medicaid services they need.  The state plans to soon publish a more detailed strategy of how it will achieve this objective.

For now, the savings generated from the transition away from FFS to KanCare will be used to increase the number of slots available for HCBS waiver services.  The State must meticulously report to CMS on rebalancing efforts vis-a-vis the waiting lists, including:

the total number of individuals in nursing facilities, and public ICF/IDs, the total number of people on each of the 1915(c) waiting lists; the number of people that have moved off the waiting list and the reason; the number of people that are new to the waiting list; and the number of people that are on the waiting list, but [are] receiving community-based services through the managed care delivery system.

Ride-alongs.  The State will conduct a “ride along” with the MCO care coordinators within the first 180 days of the carve-in for the State to observe the MCOs performing needs assessments and service plan developments. 

Call center and review of complaints and grievances.  The State will also operate a call center that will field complaint calls from beneficiaries.  This provides an independent mechanism for beneficiaries to complain about the MCOs.  The State must review call center response statistics daily for the first 30 days of the carve-in, and at least weekly thereafter up to 180 days of the carve-in.  Additionally, the State must review the MCOs’ complaint logs. 

State-MCO implementation calls.  The State must hold calls with the MCOs twice a week for the first 30 days of the carve-in, and at least weekly for the first 90 days thereafter and bi-weekly for the next 90 days thereafter.  These calls will mostly serve to troubleshoot problems and devise prompt solutions.

Quality review. The State or its External Quality Review Organization (EQRO) shall review the MCOs’ performances, in an annual review, on metrics relating to: level of care determinations, person-centered plans, MCO credentialing and/or verification policies, and health and welfare of enrollees.  To see a previous Council brief on CMS’ recent guidance for EQRO review of managed long term services and supports (MLTSS), click here.

Co-payments. Currently, no enrollees are required to make co-payments.  However, the State reserves the right to charge co-payments as stipulated in its state plan given that it provides CMS with notice at least 60 days prior to implementation.  For details, see page 23, here.


Timely payments.  As the National Council on Medicaid Home Care has discussed in its previous brief on KanCare, one of the primary provider concerns with the program has been late payments and denial of services.  The Council believes that the STCs provide insufficient assurances of timely payments based on medical necessity.  The STCs stipulate merely that “to provide for a smooth transition for beneficiaries, the state has assured CMS, through the submission of pre-implementation reports, that …a timely and efficient billing process will be established.”  Additionally, one of the jobs of the ombudsman is to “[h]elp consumers understand and resolve billing issues, or notices of non-coverage.” 

Jane Kelly, Executive Director of the Kansas Home Care Association (KHCA), stated that problems with pre-authorizations and proper payments persist with KanCare notwithstanding the recent carve-in.  She recognizes that all three of the MCOs have held conference calls with home care providers every few weeks, which helps somewhat with billing concerns.  However, she remains skeptical, stating “I don’t see where adding another huge group [i.e., the ID/DD population] on top of the current KanCare population, without first solving existing problems, will help.”  For a more complete list of KHCA member grievances, see Ms. Kelly’s article in a previous Medicaid Council Report, here.   

The Council advocates that states integrating MLTSS should institute ample training for providers to come up to speed on MCO billing systems. This can be accomplished by creating and leveraging existing stakeholder workgroups as forums where state plans can properly educate providers in how to properly submit requests for payments. Wherever possible, the Council also suggests that states implement uniform billing systems amongst all MCOs involved in MLTSS, in order to improve provider compliance and efficiency.        

Underserved waitlist.  The Council commends the State and CMS for instituting concrete steps for eliminating the HCBS waitlists, and awaits the State’s forthcoming detailed plan. 

Transitioning to MLTSS. The Council is seeing an increasing trend towards transitioning LTSS from fee for service into managed care.  The carve-in of the ID/DD population into KanCare is one of the latest developments in this trend. However, home care providers should be aware that beneficiaries and interest groups alike are voicing legitimate concerns regarding the move to managed care in Medicaid. Providers are also not powerless or voiceless in the matter. To see a recent Council brief on recommendations to providers of LTSS faced with the transition to MLTSS, click here.

Stakeholders can be very useful in improving a state’s transition to managed care in Medicaid. Likewise, if these stakeholders have outright opposition to using managed care in Medicaid, the forums are there to voice those opinions. Any state’s consideration or movement to Medicaid managed care is neither automatic nor a decision made in a vacuum.

Home care providers are encouraged to keep abreast of managed care transitions in their states, advocate on a state level, and to contact the Council with any questions or concerns.





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