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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. 

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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.

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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

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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 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

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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.

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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.

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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.

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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.

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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.

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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.

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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. 

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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.

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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.

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Frank E. Moss, former U.S. Senator

Anyone working on health care issues in Congress knows the name Val J. Halamandaris.

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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.

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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.

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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.

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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.

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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.

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Former President Bill Clinton

New Jersey Launches MLTSS

July 15, 2014 08:48 AM

On July 1, New Jersey launched its managed care long-term services and supports (MLTSS) program. Details of the transition are discussed below, as analyzed by NAHC’s affiliated National Council on Medicaid Home Care.

Populations

Two entry points. Enrollees can gain access to MLTSS either through one of five MCOs, or one of four PACE organizations through the state’s PACE program. For details, see pages 13-16, here. For a recent Council brief on PACE, click here.

Included waivers. MLTSS will encompass home and community based services previously available under waivers. These waivers include the AIDS Community Care Alternatives Program (ACCAP), Community Resources for People with Disabilities (CRPD), Global Options for Long-Term Care (GO), and the Traumatic Brain Injury (TBI) waivers. Enrollees in these waivers will automatically be enrolled in the MCOs.

Developmentally disabled. The services of the developmentally disabled population not in the above four waivers will not be affected by the transition to MLTSS.

D-SNPs. Those enrolled in dual eligible special needs plans (D-SNPs) can voluntarily enroll in MLTSS, but must first disenroll from their D-SNP plans. For details, see page 7, here.

Services

MLTSS in New Jersey now includes: assisted living, care management, community residential services, home and vehicle modifications, home delivered meals, mental health and addiction services, nursing home care, personal care, personal emergency response systems (PERS), and respite. A care manager will help coordinate LTSS with behavioral and medical services.

Private Duty Nursing. For beneficiaries up to age 21, private duty nursing (PDN) is included as a NJ FamilyCare benefit. After age 21, PDN in MLTSS is based on a beneficiary’s needs as assessed by the managed care plan. For those receiving PDN services under the current NJ FamilyCare waiver, these services may continue based on needs as assessed by the MCOs.

Provider Networks

The MCO contracts will have “any willing provider” and “any willing plan” contract provisions for two years with assisted living providers, community residential services (CRS) providers for residents with traumatic brain injury (TBI), nursing facilities, and special care nursing facilities. Personal care providers are not included in these provisions. Providers not in the MCO networks must contact these MCOs to request joining the networks.

Enrollment and Care Transitions

Enrollees of the four included waivers described above will be automatically enrolled in MLTSS through their current MCOs. Enrollees will also be given information on how to change their MCO if they would like to do so.

Others interested in enrolling in MLTSS must meet financial, clinical, and age and/or disability requirements, and must contact their local County Area Agency on Aging (AAA) or County Welfare Agency (Board of Social Services).

Providers administering services prior to the MLTSS transition can continue to do so past June 30th until the MCO has established a new plan of care for the beneficiaries, and the MCO has notified the provider of this. The MCO will then either continue to allow the provider to provide services, albeit under MLTSS, or will terminate services of that provider. It is unclear through publically available documents what, if any, obligation of notice is required for MCOs to terminate services in these circumstances.

Claims

Universal billing forms. Providers will have universal billing forms for MLTSS services, both in paper and electronic forms. For details, see page 21 and 22, here.

Claims processing. According to the MCO contracts, the MCOs must process each MLTSS service claim within 15 days of a clean submission. For non-MLTSS services, the MCOs must process these claims within 30 days of a clean submission.

Claims resubmissions. The MCOs may deny claims for a variety of reasons. The most common re-submissions types are for: bundled claims, corrected claims, and prior notification/prior authorization information.

For details of New Jersey’s move to MLTSS, click here.

Analysis

Chrissy Buteas, President & CEO of the Home Care Association of New Jersey, commented on the recent shift to MLTSS. “With the launch of MLTSS, we look forward to continued dialogue with the State and MCOs to ensure that, together, we create a landscape where patients receive the high quality services they deserve and agencies receive appropriate reimbursement levels for the essential role they play in the success of the initiative," said Buteas.

NAHC’s affiliated National Council on Medicaid Home Care expresses a couple of concerns on the launch to MLTSS, specifically:

Any willing provider. In some states, health plans will contract with any willing provider, as Texas required MCOs to do during the early years of MLTSS. Further, Centene incorporates “any willing provider” language into its contracts in Florida, and has supported “any willing provider” legislation in Kansas. New Jersey’s MLTSS to date does not have any willing provider provisions for personal care companies. The Council calls on New Jersey to move forward with “any willing provider” contracts for personal care companies. The Council continues to advocate for such provisions across all states that are transitioning to MLTSS. For details on the Council’s support of “any willing provider” provisions in home care generally, see page 47 of our 2014 policy blueprint, here.

Transition to MLTSS rates creates uncertainty. Unfortunately, New Jersey did not set any defined times for maintaining fee-for-service (FFS) rates. Essentially, the rates paid to providers can’t change until the MCOs sends in their clinicians to do an assessment. Once the MCOs conduct their assessments and make plans, then the payment to the provider adjusts from FFS to the managed care contract rate, which in the past has often been lower than FFS in New Jersey. The time it takes for the MCOs to conduct assessments varies widely (they can take anywhere from two days to two months or more), so providers have no real way to plan for when the rates will adjust.

The Council will soon have results from its July survey on MLTSS that was sent to both Forum of State Associations and home care agencies alike. Home care providers are encouraged to keep abreast of managed care transitions in their states, advocate on a state level, and to contact the Council with any questions or concerns.

 

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