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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

IN FOCUS: The FY2015 Hospice Payment Rule Part 2 – Addition of Attending Physician to Hospice Election Form and Change of Designated Attending Physician

August 25, 2014 09:39 AM

On Friday, August 22, 2014, the final rule governing hospice payment for fiscal year (FY) 2015 - 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- was printed in the Federal Register.  The rule includes final payment rate information for the forthcoming federal fiscal year and finalizes key policy changes, as well as reminds hospices that other, previously-announced changes will become effective on October 1, 2014. If hospices have not begun to prepare for these changes, they are advised to begin doing so now.

Imminent hospice policy changes addressed in the final regulation are as follows:

  • Timeframes for Filing the Notice of Election (NOE) and Notice of Termination/Revocation (NOTR)
  • Timeframe for Hospice Cap Determination and Overpayment Remittance
  • Addition of the Attending Physician to the Hospice Election Form
  • Coding Guidelines for Hospice Claims Reporting
  • FY2015 Final Payment Rates

This article provides an in-depth focus on new requirements for addition of the attending physician to the hospice election form and for documentation of a change in a patient’s designated attending physician. 

For purposes of the Medicare Hospice Benefit, a patient’s attending physician is the physician who is identified by the individual as having the most significant role in the determination and delivery of medical care to the individual at the time the individual makes an election to receive hospice care.  In recent years, CMS has received reports of hospices making the determination or assigning who will serve as a patient’s attending physician.  Additionally, CMS has noted that in 2012 more than one physician submitted claims as the hospice patient’s attending physician for approximately 35% of hospice patients.  Under current Medicare policy Hospices are required to report a patient’s attending physician on the Notice of Election (NOE).


Effective October 1, 2014 the hospice election statement must include the patient’s choice of attending physician:

  • Information identifying the attending physician should be recorded on the election statement in enough detail that it is clear which physician or NP was designated as the attending physician.
  • Hospices have the flexibility to include this information on their election statement in whatever format works best for them, provided the content requirements in §418.24(b) are met.
  • Language on the election form should include an acknowledgement by the patient (or representative) that the designated attending physician was the patient’s (or representative’s) choice.

Effective October 1, 2014 if a patient, or patient’s representative, wants to change his or her designated attending physician, the patient, or patient’s representative, must file a signed statement, with the hospice, that identifies the new attending physician in enough detail so that it is clear which physician or NP was designated as the new attending physician.

  • The statement needs to include:
    • the date the change is to be effective,
    • the date that the statement is signed, and
    • the patient’s (or representative’s) signature, along with an acknowledgement that this change in the attending physician is the patient’s (or representative’s) choice.
  • The effective date of the change in attending physician cannot be earlier than the date the statement is signed.
  • The hospice should include information such as the physician’s full name, office address, or NPI number on the election form when needed to correctly identify the attending physician chosen by the beneficiary (such as when there is more than one physician with the same last name).

Consequences:  If the election statement is not completed as required the hospice cannot bill Medicare and, upon review, if CMS finds the election statement to be incomplete or not completed correctly it could require the hospice to pay back any monies received that are tied to the election.

If the hospice does not document a change in attending physician correctly CMS could deny payment for affected days.

Hospices may also be at risk of survey deficiencies.

Tips and Notes:

CMS defines the hospice attending physician as “…either 1) a doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which he or she performs that function or action; or 2) a nurse practitioner who meets the training, education, and experience requirements described elsewhere in our regulations.”  The definition also sets out the requirement that the patient identify the attending physician at the time he or she elects to receive hospice care as having the most significant role in the determination and delivery of the individual's medical care.

There are two additional conditions of participation to note:

§418.52(c)(4) the patient has the right to choose his or her attending physician.

§418.64(a)(3) requires that if the attending physician is unavailable, the hospice medical director, hospice contracted physician, and/or hospice physician employee is responsible for meeting the medical needs of the patient.

CMS has heard about some hospice practices that are of concern.  They are a hospice:

  • Changing a patient’s attending physician when the patient moves to an inpatient setting, often changing the attending to an NP
  • Assigning an attending physician based on whoever is available

CMS clarifies in its comments that the attending physician status need not change when a patient enters GIP.  If the attending physician is not available or declines to fulfill the duties of the attending physician when the patient is in an inpatient setting, the hospice physician fills in as required at 418.64(a)(3).  This also applies when the attending physician does not have privileges at the inpatient facility. 

Hospice should document in the medical record situations where the attending is no longer willing or available to follow patient.  Hospice should inform the patient/representative that a new attending may be chosen.

Hospices are reminded that the attending physician at a facility does not necessarily meet the definition of the hospice attending physician.  For instance, a nursing home patient’s record may indicate that the medical director of the nursing facility is the patient’s attending; however, the hospice still needs to discuss this with the patient/representative and provide the patient the option of choosing an attending physician for hospice care.  CMS also clarified that a patient can choose a hospitalist to be the patient’s attending physician for hospice care; however, the hospice should notify the patient that hospitalists only follow patients who are hospitalized. 

NAHC and HAA also remind hospices that when a physician refers a patient to hospice care this does not mean the referring physician is the attending physician.  Again, the patient chooses the attending physician.

CMS will issue educational materials to alert hospices and treating physicians about inappropriate use of the attending physician modifier on claims and will update beneficiary materials.

NAHC and HAA suggest that hospices do the following:

  • Educate all staff regarding the definition of attending physician for hospice care, the patient’s right to choose the attending physician, and what process to follow and documentation necessary in instances where the attending physician is unable or unwilling to fulfill the role.
  • Modify the election statement to include:
    • Patient’s choice of attending physician.
    • Acknowledgement by the patient, or patient’s representative, that the designated attending physician was the patient’s, or patient’s representative’s, choice.
  • Develop and implement a change in designated attending physician form to include:
  • Identification of the new attending physician in enough detail so that it is clear which physician or NP was designated as the new attending physician
    • the date the change is to be effective,
    • the date that the statement is signed, and
    • the patient’s (or representative’s) signature, along with an acknowledgement that this change in the attending physician is the patient’s (or representative’s) choice.

Please Note:  The effective date of the change in attending physician cannot be earlier than the date the statement is signed.

  • Add compliance audits for attending physician choice, proper election statement requirements, and change in designated attending physician requirements.



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