Skip to Main Content
National Association for Home Care & Hospice
Twitter Facebook Pintrest
A A A
Print

Testimonials

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 element...it’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 Holds Special Open Door Forum on Hospice and Medicare Part D

April 10, 2014 03:06 PM

CMS held a Special Open Door Forum (ODF) on the topic of Medicare Part D and Hospice on April 8, 2014.  This ODF was an opportunity for providers to ask questions of CMS subject matter experts on the Part D Payment for Drugs for Beneficiaries Enrolled in Hospice – Final 2014 Guidance.  This guidance was released on March 10, 2014 and is effective May 1, 2014.  Because previous Part D guidance was ambiguous, and there were no objective criteria for sponsors to use in making Part A vs. Part D coverage and payment decisions, the policy will be applied prospectively.

During the ODF CMS reminded providers that, per statute, Medicare excludes from coverage under Part D any drugs that are available under Parts A or B.  Since hospice is a Part A benefit, drugs covered under the hospice benefit for an individual can not be covered under Part D. 

In order to avoid duplicate payments for drugs covered under hospice or waived through the hospice election, CMS directed Part D sponsors to place beneficiary-level prior authorization (PA) requirements on all drugs presented to Part D for payment for beneficiaries who are receiving hospice services.  More detailed information is found in the Part D Payment for Drugs for Beneficiaries Enrolled in Hospice – Final 2014 Guidance, which can be accessed here<​/a>.

A summary of the Special ODF highlighting frequently asked questions is below:

What is the PA process, and can the hospice initiate it?

The Part D sponsors will use the existing standard PA process, which means a reject code will be generated by the Part D sponsor for any medications presented for payment for beneficiaries receiving hospice services.  This reject code is not a denial.  It is a rejection.  This means the sponsor needs more information before the claim can be processed. Only the beneficiary/representative or the prescriber can request the PA.  The reason for this is related to the regulations pertaining to Part D plans. The PA is a determination of payment.  The hospice, the Part D plan sponsor, or the beneficiary is determined to be responsible for payment.

Although the hospice cannot initiate the PA process, it can provide information.  Both CMS and NAHC urge hospices to proactively communicate with the patient’s Part D plan sponsor.  This includes notifying the plan sponsor of the beneficiary’s hospice election (by filing the NOE as soon as possible), providing a list of prescriptions that will be presented for Part D payment and an acceptable explanation of why the medication is unrelated; as well as notifying the sponsor of a patient’s revocation or discharge.  This communication will expedite the filling of prescriptions and minimize delays for beneficiaries.  In most cases the hospices can provide this information via the plan sponsor’s pharmacy hotline.

Can the plan sponsor deny the medication even after the explanation is provided?

When a coverage determination is requested, again by the beneficiary/representative or the prescriber, the plan sponsor should contact the prescriber or the hospice and accept a verbal or written explanation of why the drug is unrelated.  It is CMS’ expectation that the plan sponsor will accept the explanation; however, this is not enforceable because there is not a regulation requiring this acceptance. However, CMS believes that the plan sponsors will comply, essentially stating that there is not an incentive for the sponsor to deny the claim after an acceptable explanation is received.  CMS stressed that an adequate explanation is a “coherent clinical explanation”.  A statement that the medication is unrelated is not acceptable and the sponsor can deny payment of the medication if there is not an adequate explanation. It is incumbent on the hospice or the provider to be clear about why the medication is unrelated to the terminal illness and related conditions.  There are other legitimate reasons why the sponsor could deny payment such as the dispensing pharmacy being out of network or the medication requires prior authorization under the sponsor’s utilization management program and those requirements have not been met

There will be no dispute resolution process in 2014, so the PA documentation will support coverage of the drug under Part D.  This policy does not affect beneficiary appeal rights. Beneficiaries retain the right to appeal Part A coverage decisions through the Medicare fee-for-service process and Part D coverage decisions through the Part D appeals process.

We are calling the Part D plan sponsor to proactively provide communication, but the sponsor states they are not aware of the PA process.

CMS reminded listeners that the sponsors just became aware of this policy on March 10, 2014 just as the hospices did.  So, it may take a little more time for all the sponsors to have adopted and implemented the policy.  CMS is hopeful that some of the problems hospices and beneficiaries have encountered, i.e. long wait times on telephone calls, etc., will improve as time goes on.  CMS recently held a call for the Part D plan sponsors on this topic which provided some answers and clarification to the Part D plan sponsors which will help with this as well.

What happens when medications are paid for by the Part D plan sponsor (after receiving an acceptable explanation), after a patient has elected hospice?  Will the sponsor chase the hospice for payment of the medications?

If the sponsor has paid for drugs after the hospice election, but before receiving notification, the sponsor should contact the prescriber or hospice for a retrospective determination of payment responsibility for the drugs. 

When a drug is determined to be the hospice’s (or beneficiary’s) responsibility, the sponsor should negotiate directly with the responsible party to recover payment.

Additional information is found in the slides used for the special ODF that can be accessed from the Hospice Center webpage

Questions can also be submitted to PARTDPOLICY@cms.hhs.gov.  Please include “Hospice” in the subject line.

 

Back

 










©  National Association for Home Care & Hospice. All Rights Reserved.