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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

An Update on Medicare Part D/ Hospice Recovery Request

June 11, 2014 11:35 AM

The National Association for Home Care & Hospice (NAHC) and its affiliated Hospice Association of America (HAA) wanted to provide an update on the Part D refund requests many hospices have received from PRS.  As was reported at the end of May (see NAHC Report, May 27, 2014), many hospices were receiving refund requests for analgesics paid for by Part D for hospice beneficiaries in 2011 and 2012.  Since that time NAHC and HAA have gained additional information that is of use and interest to hospices.  NAHC and HAA will continue to investigate the requests and will provide updated information as it becomes available. 

Below is what NAHC and HAA have learned thus far:

Optum Rx is a pharmacy benefits manager owned by United Health Group, which also owns United Healthcare.

1.  Medications are not listed on the request letter, only Rx number.  PRS has told NAHC and HAA that they cannot put the medication name in a letter due to privacy requirements. They are, however, working on developing a speadsheet that contains this information.  That spreadsheet would be specific to each hospice and could be e-mailed to the hospice in a secure format.  If the hospice is willing to receive the information this way PRS will send it.

UPDATE: NAHC and HAA does not have an anticipated completion date for these spreadsheets.  NAHC and HAA have also heard that hospices can call PRS and obtain a list, but we've not been able to confirm this.

2.  The total dollar amount listed in the body of the letter does not match the total computed when adding the dollar amounts listed with the Rx numbers.  PRS is looking into this but could not explain that at this time.

UPDATE:PRS has indicated that the list of medications that each hospice owes has been broken down into batches of approximately 45 medications.  The total dollar amount in the body of the letter, according to PRS, matches the total dollar amount owed by the hospice, which could be the total of several batches.  Each batch of medications owed by the hospice will be sent to the hospice separately so hospices could be receiving multiple letters.  At least two hospices have reported receiving more than one letter and the attachments are different.  The total dollar amount owed by the hospice is tied to its PRS number.  The PRS number is listed in the top left of the refund request letter.

3.  The letter states that the hospice has 30 days from receipt of the letter (not the date of the letter) to file a dispute.  Some hospices have been told that by filing a dispute they will not receive additional information.  It is NAHC and HAA’s understanding that it will come from PRS -  PRS will notify Optum Hospice Rx, which is PRS' customer - of the dispute and Optum Hospice Rx will decide the future course of action. We would like to have this information confirmed in writing from PRS but we do not have that at this time.

UPDATE: Neither PRS nor Optum nor United Healthcare is able to indicate what the next course of action will be in collection efforts. It is possible that there will not be any further action and it is possible that Optum/United will pursue this further.  NAHC/HAA does not anticipate CMS getting involved further in this at this time as CMS instructed the plans to recover the money from the hospices without involving the pharmacies and we believe this to be the extent of CMS involvement at this time.

4.  Hospices are reporting that they have been able to cross reference the Rx number and dollar amounts with invoices to figure out the exact medication. Upon doing so they realize that the hospice paid the pharmacy for the medication or told the pharmacy to bill them and the pharmacy did not, the medication is unrelated or unreasonable/unnecessary, and some have found that the medications are for patients who were not on service for the date listed.  These would all be reasons to file a dispute.

UPDATE: NAHC/HAA encourages hospices to verify that the patient was on service, received the medication as stated in the refund request attachment, and the medication was reasonable and necessary and related to the principal diagnosis and related conditions before paying for the medication.  Please remember that the hospice has 30 days from the date of receipt of the letter to dispute the debt.

5.  PRS has made it clear that they are willing to work with providers on payment plans.  It sounds as if they are willing to work with hospices on the issues identified and resolution.

Providers may find the following Q&A from the Part D Q&A document on the Hospice Center website helpful:

Q.6: Are all the drugs in the four categories identified in the 2014 Call Letter considered related and, therefore, covered under the hospice benefit?  Are all maintenance drugs considered unrelated and, therefore, covered under Part D?

A.6: Any drug whether it is a maintenance drug or in the four categories of [sic] identified in the 2014 Call Letter (including analgesics, antiemetics, laxatives, or antianxiety drugs) may be unrelated to the terminal illness and/or related conditions and, therefore, coverable under Part D.  As a result, coverage determinations must be made on a case-by-case basis for each drug.

The Q&A is available on the hospice center website here.

NAHC and HAA will continue to work to obtain more information and advocate on behalf of hospices, and will keep all NAHC and HAA members keep apprized of the situation as new developments unfold.




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