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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 Seeks Input on Provisions Contained in CMS’ Proposed Hospice Payment Rule

June 12, 2014 12:12 PM

On May 2, the Centers for Medicare & Medicaid Services (CMS) released a proposed regulation, Medicare Program; FY 2015 Hospice Wage Index and Payment Rate Update; Hospice Quality Reporting Requirements and Process and Appeals for Part D Payment for Drugs for Beneficiaries Enrolled in Hospice. The proposed regulation included the following:

  • Estimates of applicable FY2015 hospice payment rates;
  • Several hospice policy changes; and
  • Requests for comment on other policy changes that CMS could consider as part of future rulemaking.

CMS will accept comments until COB on July 1.

The National Association for Home Care & Hospice (NAHC) is soliciting input on four specific issues that CMS has put forth as part of the proposed rule. Those issues are:

  1. A definition for "terminal condition" that CMS may consider for use in future rulemaking
  2. A definition for "related conditions" that CMS may consider for use in future rulemaking
  3. A proposed deadline for filing a hospice Notice of Election (NOE) and Notice of Termination or Revocation (NOTR) with the MAC
  4. A requirement that a hospice patient (or representative) affirm their choice of attending physician on their election statement and affirm any change in attending physician, as well.

PLEASE SUBMIT YOUR COMMENTS ABOUT THESE CMS PROPOSALS as part of the Survey Monkey survey form NAHC has developed for this purpose. The survey is available here. Comments that are submitted will be considered for inclusion in NAHC's comment letter to CMS.  Your input must be received by COB Tuesday, June 24.  If you prefer to submit your input by email, please send your comments to Theresa Forster (

In related news, NAHC has developed a comprehensive template in Word format that stakeholders may use to develop comments they wish to submit directly to CMS on the regulation; the template is available here

The template contains information on each of the proposals in summary format.  The template also contains information on how comments on the regulatory proposals can be submitted electronically.

Following are the specific issues and questions for consideration that are included as part of NAHC’s survey that is linked above:

1. DEFINITION OF “TERMINAL ILLNESS.”  CMS believes that longstanding, preexisting conditions should be considered part of the bundle of covered hospice services, that all body systems are interrelated; all conditions, active or not, have the potential to affect the total individual. The presence of comorbidities is recognized as potentially contributing to the overall status of an individual and should be considered when determining the terminal prognosis. The 1983 rule governing creation of hospice under Medicare does not delineate between pre-existing, chronic, nor controlled conditions.

CMS is asking for comment on a definition for "terminal illness" that it has developed, as follows:

TERMINAL ILLNESS -- “Abnormal and advancing physical, emotional, social and/or intellectual processes which diminish and/or impair the individual’s condition such that there is an unfavorable prognosis and no reasonable expectation of a cure; not limited to any one diagnosis or multiple diagnoses, but rather it can be the collective state of diseases and/or injuries affecting multiple facets of the whole person, are causing progressive impairment of body systems, and there is a prognosis of a life expectancy of six months or less”.

Questions to consider as you provide your input: As a hospice medical or clinical staff member, do you believe this definition is appropriate or is it too broad? If you were to apply this definition to patients under care at your hospice, would it result in the same determination as you are currently making relative to what care/services are the responsibility of your hospice and what responsibilities fall outside of hospice care?

2. DEFINITION OF "RELATED CONDITIONS"-- CMS includes a definition of "related conditions" and requests input on this definition:

RELATED CONDITIONS -- “Those conditions that result directly from terminal illness; and/or result from the treatment or medication management of terminal illness; and/or which interact or potentially interact with terminal illness; and/or which are contributory to the symptom burden of the terminally ill individual; and/or are conditions which are contributory to the prognosis that the individual has a life expectancy of 6 months or less”.

Questions for hospices to consider as you comment on this definition: As with definition of “terminal illness” (above), do hospice medical/clinical staff believe this definition is appropriate or is it too broad? If you were to apply this definition to patients under care at your hospice, would it result in the same determination as you are currently making relative to what care/services are the responsibility of your hospice and what responsibilities fall outside of hospice care?

3. Timeframes Proposed for Filing NOE and NOTR.CMS proposes that:
(1) a hospice must file the NOE with its MAC within 3 calendar days following the hospice effective date of election, regardless of how the NOE is filed (by direct data entry, or sent by mail or messenger). Hospices not filing the NOE within the required 3 calendar days would receive no payment from the effective date of election to the date the NOE is received by the MAC, and could not bill the beneficiary for the services provided.

(2) similarly, a hospice must file a notice of termination/revocation (NOTR) within 3 calendar days following the patient’s revocation/discharge date if a final claim has not been filed within that time frame.

CMS proposes these time frames to safeguard the integrity of the Medicare Trust Fund and enable smooth and efficient operation of other Medicare benefits (i.e. Part D); additionally, timely filing of the NOE is necessary so that the Medicare claims processing system can properly enforce the Medicare hospice benefit waiver.

Questions to consider as you provide comment on this proposed requirement: From the hospice perspective, a 3-day requirement may be burdensome, particularly for small hospice providers and those who file by mail/messenger. What is the shortest amount of time (following the effective date of election) within which your hospice would be able to file ALL of its NOEs with the MAC? Within what time frame would your hospice be able to file ALL of its NOTRs?

4. Designation of Attending Physician.  CMS is concerned that hospices may be assigning patients' attending physicians rather than ensuring that the choice of attending is made by the patient or patient's representative. CMS is proposing that the election statement identify the patient's (or representative's) choice of attending physician and include an acknowledgement by the patient (or representative) that the designated attending physician was their choice. CMS is proposing that, when a patient changes his/his attending, the hospice follows a process similar to that in use when the patient changes hospice providers; that is, the patient (representative) signs and dates a statement that identifies the new attending physician and affirms that the change was the patient's (or representative's) choice.

To consider when you comment on this proposed change: how might these procedural changes for designation of attending physician impact your hospice's operations? What circumstances would make it difficult to comply with these changes?




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