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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

NAHC/HAA Host Free Teleconference on CMS’ Proposed Regulation for FY2015 Hospice Payment and Policy Changes

May 14, 2014 04:56 PM

The National Association for Home Care & Hospice (NAHC) and its affiliated Hospice Association of America (HAA) recently held a teleconference on the subject of CMS’ proposed regulation for FY2015 hospice payment and policy changes. NAHC President Val J. Halamandaris led the teleconference, and was joined by Bill Dombi, NAHC’s Vice President for Law; Theresa Forster, NAHC’s Vice President for Hospice Programs, and; Katie Werhi, NAHC’s Hospice Operations and Regulatory Expert.

The call was offered to NAHC and HAA members free of charge, and covered a range of topics surrounding CMS’ proposed FY2015 regulations for hospices.

NAHC’s President Val J. Halamandaris started the call by asking the panel of experts what their initial reaction to the proposed rule was.

“This [regulation] was a bit of a surprise,” said NAHC Vice President for Law Bill Dombi. “CMS is very cautious about making changes to hospice…they are taking a deliberative path and they’re very serious about bringing oversight into hospice. [The proposed regulation] is driven by statistics and abnormalities and have highlighted all their areas of concern.”

“What’s interesting is what CMS did not do as part of this regulation. The organization did not put forth any payment reform changes and the regulatory changes that they are proposing are somewhat limited in scope,” said Theresa Forster, NAHC’s Vice President for Hospice Programs. “What is really significant is some of the tone that is used… They are concerned enough [by their research findings related to payment reform that their focus has shifted to] what they can do to beef up program integrity measures and hold off on payment reform until a later date.”

“My first reaction was the tone of the comments and the possible redefinition of the hospice benefit,” said NAHC’s Hospice Operations and Regulatory Expert Katie Wehri. “I was a little surprised that there wasn’t payment reform information but pleased that there is a deliberate approach to gather more data to make the right determination, but really concerned about the tone and approach and what it means to the difference between how hospices have been operating for the last 30 years and what it means for the future.”

“Looking at the regulations, what it said to me is our friends at CMS have a “get tough” approach to hospice, and they’re going to do everything they can to tighten things up before they take the leap of reforming the hospice payment system,” said NAHC President Val J. Halamandaris before asking Ms. Forster to detail some of the specifics of the proposed regulation.

For more on the specific proposals contained in the proposed regulation, please see NAHC Report, May 5, 2014.

When Mr. Halamandaris asked Katie Wehri what the single biggest issue in the proposed regulations is, her response was, “the implications that hospices are potentially not covering care and services that CMS believes should be part of the hospice benefit…There’s a strong signal that CMS is in the process of revising what hospice is considered to be by most of us in the field. It’s pretty ironic that they didn’t propose a rule change, but they do appear to have a change in interpretation.”

The conversation then moved to CMS’ allegations that some hospices were abusing the system by engaging in “reverse bundling” - under which hospices are shifting payment responsibility for some services to other parts of the Medicare program.

Mr. Halamandaris asked what the prospects for a legal challenge were. Mr. Dombi suggested that the hospice field would need to wait and see how the changes were manifested and how CMS chooses to apply the proposed regulations.

“There’s no [foundation] for litigation right off the bat, but it is something that we will be watching very, very carefully,” explained Mr. Dombi. “If you wanted to predict what you’ll see out of this rule: a Medicare contractor reads it, and they’re going to deny a lot of claims retroactively. They’re going to say that all services are paid for by the hospice and none will be paid for by Part A, Part B or Part D Medicare, and that’s when we’re going to see some legal challenges.”

Despite the lack of payment reforms contained in the proposed regulation, Ms. Forster explained that CMS did include a 1.3 percent increase in payment. That payment increase, however, fails to take into account the 2 percent cut that was mandated by the sequester, and as a result hospices will have to, “try to do more with less.”

When the conversation returned to when structural changes to the hospice payment model may occur, Mr. Dombi suggested that, “we’re looking at a minimum of two and possibility of three or more years before any significant structural payment reforms will be made to the hospice benefit.”

“On payment reform, we haven’t moved forward. We’ve moved to the side,” added Ms. Forster.

“If we’re waiting two, three, four years before we have some payment reform, one of the concerns becomes how to care for the short stay patient. These patients’ care is very costly to the hospice, and I hope that the deliberate approach taken by CMS on payment reform does not discourage hospices from caring for those kinds of patients, though hospices with a high proportion of short stay patients will be in trouble financially,” said NAHC’s Vice President for Law Bill Dombi.

Short stay patients are a real and growing concern for hospices. Theresa Forster cited Congressional Budget Office data indicating short stay patients made up 5 percent of the hospice population in 2000, and had increased to 10 percent by 2009. “This is becoming a greater concern for hospices.”

Katie Wehri was asked to explain what “unbundling” means within the proposed regulation. “It is looking at charges for care to hospice patients outside of the Medicare hospice benefit. Among other things, CMS is looking at patterns of when a beneficiary has elected the hospice benefit, revokes the benefit and, in the interim, care is charged to other parts of Medicare and then the patient reelects hospice care. CMS is looking at charges the hospice should be incurring that are being picked up by another part of Medicare.”

“Discussions I am hearing about unbundling is that CMS is going to presume that all services are the hospice’s responsibility – a shift of potentially more than a billion dollars from Parts A, B and D to hospices. That’s almost 7 percent of the current hospice benefit [which is equivalent to the average hospice financial margin], and it could put a lot of hospices under water,” added Mr. Dombi.

As the conversation moved to ways hospices can prepare for looming changes and how to weather CMS’ proposed regulations, the panel offered positive parting thoughts on how hospice is evolving.

NAHC President Val J. Halamandaris encouraged everyone to keep in mind that, “the regulatory process holds promise. It’s just as easy to believe that CMS is going to do the right thing coming from the right place as it is to believe that they’re going to do the wrong thing coming from the wrong place. Let’s do everything we can to help them, and give them everything they need to make sure this benefit is perfected and not undermined. We are delighted to have the opportunity to advocate for all of you on behalf of hospice whether it be with CMS or with Congress.”

To hear the full teleconference, please click here.





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