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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

President’s Budget Includes Provisions for Home Health Copays, Additional Payment Cuts for Post-Acute Care Providers

Budget includes other proposals – bundling and value-based payments – impacting home health care
March 7, 2014 10:00 AM

President Obama released his 2015 budget proposal earlier this week, laying out his agenda and legislative priorities for the coming year. Two of the provisions included in President Obama’s FY15 budget are similar to previous proposals that would be of great concern to the home health community. For more on NAHC’s position on these budget proposals, please see NAHC Report, March 5, 2014.

Specifically, President Obama’s budget once again calls for the introduction of a home health copayment - as well as further cuts to post-acute care providers, including home health care.

President Obama’s budget also includes provisions for a bundled payment program for post-acute providers, as well as value-based purchasing for post-acute care providers. The specifics of these four proposals are included below:

Introduce Home Health Copayments for New Beneficiaries

This proposal would create a co-payment for new Medicare beneficiaries (those who become eligible for Medicare in 2018 and thereafter) of $100 per home health episode, starting in 2018. Consistent with MedPAC recommendations, this co-payment would apply for episodes with five or more visits not preceded by a hospital or inpatient post-acute stay. [$820 million in savings over 10 years].

NAHC opposes the introduction of a home health copayment, stating explicitly in its 2014 Legislative Blueprint for Action that: “Congress should oppose any copay proposal for Medicare home health services and prohibit Medicare Advantage plans from charging a home health copay. Reinstating the copay today would directly conflict with the goal of Congress to modernize the Medicare program. “

Adjust Payment Updates for Certain Post-Acute Care Providers

This proposal reduces market basket updates for inpatient rehabilitation facilities, long-term care hospitals, and home health agencies by 1.1 percentage points in each year 2015 through 2024. This proposal reduces market basket updates for skilled nursing facilities (SNF) under an accelerated schedule, beginning with a -2.5 percent update in FY 2015 tapering down to a -0.97 percent update in FY 2022. [$97.9 billion in savings over 10 years].

NAHC opposes Medicare home health payment cuts, and states in its 2014 Legislative Blueprint for Action that, “Congress should reject any proposals to reduce the market basket inflation update or impose additional rate reductions for home health agencies.”

Implement Bundled Payment for Post-Acute Care Providers

Beginning in 2019, this proposal would implement bundled payment for post-acute care providers, including long term care hospitals, IRFs, SNFs, and home health providers. Payments would be bundled for at least half of the total payments for post-acute care providers. Rates based on patient characteristics and other factors would be set so as to produce a permanent and total cumulative adjustment of 2.85 percent by 2021. [$8.7 billion in savings over 10 years].

NAHC believes that bundled payments for post acute care should provide an appropriate focus and emphasis on home health. In its 2014 Legislative Blueprint for Action, NAHC states that:

“Congress should monitor the bundling pilot program authorized by PPACA to ensure a reasonable and fair opportunity for home health agencies to participate in and/or manage the payment bundle for post acute care. Such an approach would deter unnecessary re-hospitalizations, thus reducing administrative burden and cost, as well as increase the quality and availability of home health care. This approach is comparable to the tried and tested Medicare hospice program where payment is bundled to a community-based hospice program where hospitalization is the exception rather than standard practice.”

Establish Value-Based Purchasing

The Affordable Care Act established a value-based purchasing program for hospitals and required CMS to develop plans to implement value-based purchasing for SNFs, home health agencies, and ambulatory surgical centers. Implementing these provisions will continue to be a high priority for CMS in FY 2015, which will be the third year of quality-based payment adjustments for hospitals, and will include patient mortality measures for the first time.

With regard to value-based purchasing proposals, which are often referred to as “Pay-For-Performance,” NAHC states in its 2014 Legislative Blueprint for Action that: “Congress should monitor the progress of the ongoing Pay-For-Performance demonstration and use the findings to guide its consideration of a full-fledged value-based payment system for Medicare home health services.”

The President’s 2015 budget also contains numerous additional health care provisions, including:

  • Reducing Medicare coverage of bad debts ($30.82b);
  • Cuts to graduate medical education payments ($14.64b, although the budget also includes $5.23 billion in new GME funding for additional residencies);
  • “Reduce fraud, waste, and abuse in Medicare” ($400m);
  • Part D rebates for LIS beneficiaries ($117.25b);
  • Accelerate discounts of branded drugs in the donut hole ($7.85b);
  • “Modify reimbursement of Part B drugs” ($6.75b);
  • “Modernize payments for clinical laboratory services” ($7.89b);
  • Increase the minimum MA coding intensity adjustment ($30.96b);
  • Align employer group waiver plan payments with average MA plan bids ($3.74b);
  • “Strengthen Independent Payment Advisory Board” ($12.94b);
  • Means-testing for Parts B and D ($52.79b);
  • Introduce a Part B surcharge for new beneficiaries who purchase near first-dollar Medigap coverage ($2.74b);
  • Encourage the use of generic drugs by low-income beneficiaries ($8.49b);
  • Rebase DSH allotments ($3.26b);
  • Reduce Medicaid waste, fraud, and abuse ($692m);
  • Strengthen the Medicaid drug rebate program ($7.52b);
  • Exclude brand-name and authorized generic drug prices from Medicaid Federal upper limit (FUL) ($1.04b);
  • Increase access to and transparency for Medicaid drug pricing data ($30m in spending);
  • Prohibit pay-to-delay agreements ($11.05b);
  • Modify exclusivity period for biosimilars ($4.2b); and
  • Accelerate the issuance of State innovation waivers (no score).

While it is unlikely that Congress will give much consideration to the President’s budget this year, the fact that certain provisions targeting home care are again included is cause for concern. Since Congress is struggling to come up with offsets for fixing the flawed Medicare physician payment formula (SGR), there is the danger that lawmakers could turn to one or more of the President’s Medicare proposals to find savings. NAHC encourages all of its members to join with their peers and colleagues later this month for the March on Washington to continue to fight against misguided proposals such as the reintroduction of a home health copayment or additional payment cuts.

For more on the March on Washington, please click here.




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