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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

Proposed Medicare Home Health Services Rates Would Reshape Payments Significantly

July 31, 2014 11:06 AM

With the Notice of Proposed Rulemaking, the Centers for Medicare and Medicaid Services (CMS) sets out a plan to recalibrate all 153 Home Health Resource Groups in the case mix adjustment model. These proposed changes, if finalized later this year, would result in a dramatic reshaping of the payment distribution model. CMS has evaluated and modified all variables that affect the assignment of an HHRG to a particular patient episode.

The recalibration is based on the methodology that was used to modify the 2008 and 2012 case mix adjustment weights. CMS used preliminary 2013 home health claims data for generating the proposed 2015 case mix weights. The dependent variable that was used in the recalibration is the same that was applied in 2012: wage weighted minutes of care using Bureau of Labor Statistics data on national hourly wage plus fringe rates for the six disciplines of care. All 164 variables in the four-equation model were examined. The four-equation model consists of four “legs:” early episode 0-13 therapy visits; early episode 14+ therapy visits; later episode 0-13 therapy visits; and later episode 14+therapy visits. The evaluation affects both the Clinical and Functional domains in the model.

The CY 2015 four-equation model resulted in 121 point-giving variables being used in the model (as compared to the 164 variables for the 2012 recalibration). There were 19 variables that were added to the model and 62 variables that were dropped from the model due to the lack of additional resources associated with the variable. The points for 56 variables increased in the CY 2 015 four-equation model and the points for 28 variables in (sic) decreased in the CY 2015 for-equation model.   

The bottom-line is that the proposed case mix adjustment model has had nearly all of its inputs that affect the calculated case mix weight redone resulting in wholesale and HHRG-specific changes to all HHRGS. CMS claims that the new model is more accurate in terms of correlating the case mix weights to the resources used in each HHRG category. The 2012 version has an R-squared (explanatory power) of 0.3769 while the proposed model’s R-squared is 0.4691.

In recalibrating the case mix weights, CMS revises the weight associated with therapy utilization. HHRGs weights associated with 0-5 therapy visits were increased by 3.75 percent; 14-15 therapy visits decreased by 2.5 percent; and 20+ therapy visits decreased by 5 percent. However, this does not mean that the resulting case mix weights are all affected to the same degree. Instead, therapy utilization is just one of the variables in the case mix weight calculation. Although the adjustments on therapy utilization impact the final weights, they do not control the outcome. In fact, the final proposed weights actually show higher weights on high volume therapy episodes than under the present case mix weight calibration.

As is shown in the chart (link here), the actual impact of the case mix weight recalibration on payment levels is anything but consistent in each of the 153 HHRGs. Throughout the model case mix weights are increased and decreased individually at various levels. Furthermore, HHRGs associated with 20+ therapy visits go up significantly, but inconsistently in relation to the CY2012 currently in use.

For example, Payment Group 40111, HHRG C1F1S1 20+ therapy visits would be paid $5324.52 on a base episode, non- wage indexed adjusted rate in contrast to $4804.71 in the 2014 HHRG weight calibration. In comparison, Payment Group 10131, HHRG Early Episode, 0-5 therapy visits would lead to a 2015 payment level of $2322.08 compared to $2393.83. The continued rate rebasing affects both HHRGs in a proportionate equal manner. It is very noteworthy that the higher therapy volume HHRG goes up despite the 5 percent reduced weight assigned to the service utilization variable of 20+ therapy visits. The reason is that the other variables in the calculation show a higher overall resource use.   

For HHAs wishing to evaluate the impact of the proposed rule, including the case mix weight recalibration, on the organization, it is necessary to perform an HHA-specific comparison using a recent case mix census. Since the recalibration has inconsistent outcomes between and among the HHRG, only by way of an application of the HHA’s own case mix experience can the impact be reasonably forecast. Even then, the forecast assumes that the nature of the case mix census is consistent between 2014 and 2015. While CMS forecasts that nonprofit HHAs will fare better than proprietary and Northern HHAs better than Southern ones, the reality is that each HHA must be individually evaluated regardless of location, tax status, or ownership.

In an upcoming article, NAHC will review the proposed changes to the area wage index. Each year, wage index changes have the potential to trigger significant reimbursement changes. The 2015 proposal offers a 50/50 blend of 2015 CBSAs with 2015 new CBSAs.  Under the proposed change, there are 7 new CBSAs, 208 counties changes CBSA designations with 38 shifting from urban to rural, 105 rural to urban, and 65 shifting from one rural area to another rural area.

To view a chart of the proposed case mix adjustments, please click here.




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