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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

IRS Employer Mandate Rule has a Home Care Focus

February 26, 2014 09:24 AM

The Internal Revenue service (IRS) recently released it Final Rule implementing the “Shared Responsibility for Employers Regarding Health Coverage” under the Affordable Care Act. NAHC previously reported on the rule – see NAHC Report, February 12, 2014 - which is most notable for its one-year postponement of the health insurance and penalty provisions for employers with 99 or fewer full-time and full-time equivalent employees. That final rule also modified the standards and penalty calculation for employers with 100 or more full-time and full-time equivalent employees, permitting an employer to offer insurance to 70 percent of its full-time employees in 2015 in contrast to the original 95 percent standard. The rule also provides a one-year, additional 50 exemptions in the calculation of any penalty for employers 100 or more beyond the original 30 exemption.

Among the 227 pages of the Final Rule is a home care-specific discussion. In response to requests from the home care community for an exception from the employer mandates, the IRS states that the law “applies to all applicable large employers and does not provide an exception, either for employers in a particular industry such as the home care industry, or for employers with more difficulty adjusting revenue streams.”

The IRS goes on to suggest that certain home care companies may not be subject to the mandates at all:

“…in some circumstances the service recipient rather than a home care agency may be the common law employer of the health care provider. For example, if the service recipient has the right to direct and control the home care provider as to how they perform the services, including the ability to choose the home care provider, select the services to be performed, and set the hours of the home care provider, these facts would indicate that the service recipient is the employer under the common law standard. In that case, the agency that placed the home care provider would not be subject to section 4980H with respect to that particular provider, and the service recipient employer generally would not be subject to section 4980H with respect to any employee because the service is unlikely to employ 50 full-time employees (including FTEs).”

NAHC cautions against an over-application of the IRS guidance. The standards for determining which party or parties is/are the employer of a home care worker are very complex and fact-dependent. It is virtually impossible for a Medicare participating home health agency or hospice to avoid the employer role unless the individual is the employee of an entity contracting with the provider. The Conditions of Participation put all caregivers under some entities supervision and control rather than the care recipient. Similarly, Medicaid provider standards almost uniformly put a home care agency in a position of controlling caregivers.

Even in a Medicaid consumer directed care program, a “fiscal agent” might operate in a manner that results in a joint-employer status. For example, the California Supreme Court recently affirmed a lower court ruling that counties in the state are the joint employers of caregivers providing consumer-directed care in its In Home Supportive Services Program.

Private pay personal care services agencies also should closely examine how it manages the provision of care to determine whether they would be considered the employer or joint-employer with the care recipient. In a pure “registry” model it may be possible to avoid the employer responsibilities provided there is not right to or actual supervision, oversight, or control of the worker. Each such company should carefully examine how it is operating and utilize competent legal counsel to evaluate employer status.

Home care companies should also recognize that the IRS provides no forgiveness for good-faith errors in classifying workers under the ACA employer mandates. While there is a general IRS law that can offer some safety for honest mistakes made in employee/employer classifications, the employer mandate rule issued by the IRS clearly states that the so-called Section 530 “applies solely for purposes of the employment tax provisions of the Code, and therefore does not apply to potential liabilities under section 4980H.”

NAHC continues to seek relief for home care and hospice companies from the burdensome and potentially insurmountable obligations under the ACA. For example, a pending reform proposal that has some bipartisan support would redefine “full-time” as workers with 40 or more hours worked in a week instead of the ACA standard of 30 hours.

There has been considerable recognition of the home care industry’s concerns with the employer mandate as well as positive action such as the initial one year delay and the recent transitional relief.




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