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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

NAHC to Submit Additional Comments to MedPAC on Rebasing

Additional comments are needed because MedPAC commissioners are not fully informed with respect to the severe consequences that rebasing will have on access to and quality of home care services
April 4, 2014 10:10 AM

Bill Dombi, NAHC Vice President for Law, recently attended a MedPAC session on the topic of home health rebasing. The session made clear that MedPAC still does not see rebasing as adversely affecting quality or access to home health care. To support that view, MedPAC staff offered flawed statistics that home health agencies will experience a net rate cut of just 1.6 percent by 2017 – or 3.6 percent if sequestration is considered. That cut level is calculated by offsetting the rebasing cuts with annual Market Basket Index inflation updates. As such, it is based on the unfounded assumptions that home health agencies will face no cost increases in the next four years or that Medicare revenue increases can offset higher costs.

MedPAC staff explained that previous rate cuts have had little to no effect on Medicare margins, as home health agencies increased revenue per episode through case mix weight upcoding.

This analysis is nothing more than a retread of what MedPAC has said for years -most recently in its March report to Congress. The analysis continues the same flawed approach that ignores costs that home health agencies incur, such as telehealth, and further assumes that home health agencies will somehow find opportunities for further upcoding and cost reductions. The most recent data from 2011 and 2012 belie those assertions as coding weight changes have been negligible, episode costs have increased with new regulatory requirements, and average Medicare margins have declined for two consecutive years.

Essentially, MedPAC offers a forecast based on incomplete information that goes well beyond reasonable assumptions and accepted methodologies for policy recommendations. Notably, MedPAC staff glossed over the significant fact that margins have declined precipitously in both 2011 and 2012, suggesting that the cost/revenue/coding assumptions MedPAC used is well-founded. MedPAC’s own analysis shows a cumulative 4.8-point drop in freestanding HHA margins during that period; NAHC data also confirms these margin reductions.

As a group, the MedPAC commissioners noted the importance that home health care plays in a calibrated and evolving healthcare delivery system. However, the MedPAC commissioners also expressed the belief that just because home health is a highly valuable service, that does not justify “overpaying” for it. In other words, the MedPAC commissioners are weary of any individual segment that has perceived “high” Medicare margins. 

Commissioners and MedPAC staff have been unwilling to publicly state what level of average margin should be considered “high” or leading to “overpayments.” In other health care sectors, MedPAC continues to suggest limited inflation updates even when margins average below zero, e.g. inpatient hospital Medicare margins average -7 percent.

With respect to the CMS admission that at least 43 percent of home health agencies will have negative margins by 2017, MedPAC staff expressed the belief that it has been normal to have 30-plus percent of home health agencies with negative margins and no access problems. Furthermore, MedPAC staff expressed the opinion that the CMS estimate is wrong.

The full transcript of the session should be available in the coming days. MedPAC accepts comments for one week following their sessions. NAHC is in the process of drafting comments and submitting them to MedPAC. Once the comments are prepared, they will be shared via NAHC Report.

For more on MedPAC’s recommendations and NAHC’s advocacy, please see NAHC Report, March 21, 2014.




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