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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

Hospice Diagnosis Reporting on Claims

August 28, 2014 10:34 AM

On Friday, August 22, 2014, the Centers for Medicare & Medicaid Services (CMS) released Change Request 8877/Transmittal 3032: Hospice Manual Update for Diagnosis Reporting and Filing Hospice Notice of Election (NOE) and Termination or Revocation of Election. CR8877 provides instruction on systems edits that CMS will put in place for claims submitted on or after Oct. 1, 2014, that will return to provider (RTP) claims including a principal diagnosis that does not comport with ICD-9-CM coding guidelines and conventions. 

Under this change, claims - including any of the following - as a principal diagnosis will be subject to the RTP edit:

  • Debility
  • Failure to Thrive
  • Codes classified as “manifestation codes” in the Medicare Code Editor (V. 31.0 Oct. 2013)
  • Codes listed in Attachment A of CR8877

Through these edits, CMS is seeking to ensure that hospice providers utilize a principal diagnosis that represents the condition most contributory to the patient’s terminal prognosis. Manual changes included as part of the CR specify the following diagnoses as non-reportable as principal diagnosis codes:

  • ICD-9-CM v-codes and ICD-10-CM z-codes
  • Debility, failure to thrive, or dementia codes classified as unspecified
  • Codes that are prohibited for use as a principal diagnosis according to ICD-9-CM or ICD-10-CM coding guidelines or that require further compliance with ICD-9-CM or ICD-10-CM coding conventions, such as those that have principal diagnosis code sequencing guidelines

CMS has also specified in the manual changes that, “All of a patient’s coexisting or additional diagnoses that are related to the terminal illness and related conditions should be reported on the hospice claim.”  While CMS has not initiated an edit at this time to RTP claims that do not provide more than a single diagnosis on hospice claims, in recent years the majority of claims submitted by hospice providers contain only a single diagnosis code.  CMS is closely watching provider behavior relative to this longstanding practice and may consider changes in the future to encourage hospice compliance.

While most hospice providers have been working to eliminate use of “debility” or “failure to thrive” as a principal diagnosis in recent years, hospices must now take similar steps to eliminate use of the other codes that, if used as a principal diagnosis, will result in the hospice claim being returned for a more appropriate principal diagnosis. 


  • Identify existing clients for which your hospice currently uses a non-allowed code as the principal diagnosis.
  • Encourage the hospice team, with involvement of staff with training in proper ICD-9-CM coding principles, to discuss alternative diagnoses that might more appropriately represent the diagnosis that is most contributory to the patient’s terminal prognosis.
  • Keep in mind that CMS has indicated that while it is the hospice physician that identifies the diagnoses that establish a six-month prognosis, it is permissible that staff trained in coding principles select the appropriate diagnosis codes.
  • Make sure that your hospice has someone on staff/contracted who is trained in ICD-9-CM coding requirements
  • Ensure continued education of appropriate individuals for ICD-10-CM training (ICD-10 goes into effect October 1, 2015)
  • Consider what, if any, additional information the intake/admission team needs to collect in order for the physician to have enough information to best determine the principal and related diagnoses
  • Ensure compliance with the requirement that all of a patient’s coexisting or additional diagnoses that are related to the terminal illness and related conditions are going onto the hospice claims



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