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National Association for Home Care & Hospice
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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

Home Infusion Demo Maps A Way Forward For Future Medicare Changes

The following article was written by Beth Mantz Steindecker, Vice President, Health Care Analyst at Washington Analysis, an institutional research firm
August 19, 2014 08:59 AM

A Medicare demonstration project bundling payment for home infusion of intravenous immune globulin (IVIG) maps a potential way forward for future reimbursement changes involving home infusion more broadly, which would benefit larger providers like BioScrip, Walgreen, CVS, Express Scripts, privately-held Diplomat that recently filed an S-1 and privately-held AxelaCare Health.  While the demonstration will have limited impact in the near term, given that insurers tend to piggy back on Medicare even though it comprises less than 15-20% of the industry payer mix for specialty home infusion providers, the policies CMS wants to test could have reverberating effects among all insurers and bring consistency to the current haphazard state of home infusion reimbursement. 

Any benefit from such potential changes would come on top of various positive underlying factors: (1) a growing Medicare population; (2) expansion of insurance coverage; (3) the need for insurers and/or PBMs to have sufficient pharmacy networks that offer specialty and home infusion drugs; (4) an increased emphasis on cost-effective strategies, especially those designed to keep people in the home; and (5) the fact that many infused therapies lack treatment alternatives for chronic conditions like immunodeficiencies, autoimmune disorders, and hematologic disorders.  These factors have led to some consolidation among this fragmented industry over the years [e.g. Walgreen's purchase of Express Script's CuraScript and Omnicare's Option Care; Express Script's merger with Medco and its Accredo unit; CVS's purchase of Coram from privately-held Apria; BioScript's buying spree of CarePoint, HomeChoice Partners, and InfuScience; and Diplomat's purchase of privately-held MedPro Rx.]

Recently, CMS said it is setting up a three-year demonstration project to bundle payment for IVIG supplies and services for home use to Medicare beneficiaries who are not home-bound or receiving home health. Ordered by statute and starting in October, the project is restricted to 4,000 patients with primary immune deficiency disease (PIDD).  Although limited in scope, this project is being watched by CMS, MedPAC, policymakers, and patient groups to monitor access, compliance, and healthcare outcomes to see if this design can apply to home infusion more broadly, considering that more people are entering the system and suffering from chronic illnesses that may be more cost-effectively treated in the home.

The current reimbursement framework for home infusion is convoluted. Most insurers and government programs pay a separate rate for the infused therapy - and potentially a per-diem amount for the supplies, equipment, and pharmacy services - and another amount for nursing.  Medicare heeds this piecemeal approach but often does not reimburse for the supplies and nursing, since such coverage depends on the actual therapy, patient's illness, and circumstances.  Given that insurers use Medicare as a guide, any policy changes to make home infusion more comprehensive would be felt more broadly, including potential disruption to smaller operators lacking the infrastructure to handle the service/patient volume or absorb cost increases. 

Medicare's various forms of home infusion:

  • Home infusion for IVIG is reimbursed under Medicare Part B for patients with PIDD at a statutory rate of 106% average sales price.  Unless the beneficiary is homebound or eligible for home health as part of post-acute care, CMS won't pay for any nursing or supplies to administer IVIG.  Additionally, most Medicare claims for IVIG are for other illnesses and are not reimbursed under this paradigm, often forcing patients to be treated outside the home, at a cost to the government.
  • Home infusion for select anti-infective, chemotherapy, inotropic, and pain management therapies may be paid under Medicare Part B at a different rate, but only for (1) certain indications; (2) homebound beneficiaries; and (3) administration with an external infusion pump - thus triggering Medicare's durable medical equipment benefit.  CMS will not pay for nursing care unless the patient is eligible for home health.
  • Home infusion for other treatments, such as antibiotics or rheumatoid arthritis, off-label indications for the therapies above, or for beneficiaries that are not homebound, Medicare Part D provides the treatment and reimburses the home infusion pharmacy at a negotiated rate, but it does not reimburse for any ancillary supplies or nursing service.



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