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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

Navigating the New Hospice Cost Report

September 9, 2014 04:13 PM

Editor’s Note:  Special thanks to Simione HealthCare Consultants, authors of the following article regarding changes to the hospice cost report, for permission to reprint the article in its entirety.  This article contains material that was presented by Robert J. Simione, Managing Principal of Simione Healthcare Consultants, LLC, on September 4, 2014, as part of the NAHC teleconference, “What Do CMS’ Hospice Cost Report Changes Mean to You?”  A replay of the teleconference is available here.

On August 29, 2014, the Centers for Medicare & Medicaid Services (CMS) released the new cost report requirements for freestanding hospice organizations. As a result, freestanding hospices will no longer complete the Form CMS 1984-99, but rather the Hospice Cost Report Form CMS 1984-14. Significant changes also include new forms that need to be completed, and more detailed financial reporting to capture required data.

The implementation date for the new cost report is for cost reporting periods beginning on or after October 1, 2014.

New Worksheets

Additionally, there are a number of completely revised and different worksheets. Worksheet S-2 replaces the CMS 339 Questionnaire and worksheets A-1, A-2, A-3 and A-4 now require you to record direct patient care costs by each of the four levels of care. Some of the worksheets look the same, but there are some small revisions to the forms. For example, worksheets such as the A-6 Reclassifications will be completed the same way, but now there is a column added that reflects the new level of care number/worksheet as needed.

The components of the new worksheet S-2 include:

  • Provider Organization and Operation
  • Information relative to change in ownership, terminating participation and home office.
  • Financial Data and Reports
  • Financials and whether they are audited, compiled or reviewed.
  • PS&R Report Data
  • Was the PS&R used and/or any changes to the data?
  • Cost Report Preparer Contact Information

The direct patient care worksheets by level of care are:

  • A-1 is for Continuous Home Care
  • A-2 is for Routine Home Care
  • A-3 is for Inpatient Respite Care
  • A-4 is for General Inpatient Care


This is a new section on worksheet S-1. A few questions relating to malpractice insurance need to be answered. These questions related to the amount of malpractice premiums, paid losses and/or self-insurance must be entered as well.

CBSA Codes

An additional part of worksheet S-1 is the requirement to enter CBSA codes where Medicare-covered hospice services were provided during the cost reporting period.

Worksheet A – A Few Key Notes

There have been significant changes to the cost centers. A number of general service cost centers have been added, and the direct patient care and non-reimbursable cost centers have been expanded, as well.

Some of the new general service cost centers include:

  • Employee Benefits
  • Laundry & Linen
  • Housekeeping
  • Dietary
  • Nursing Administration
  • Routine Medical Supplies
  • Medical Records
  • Staff Transportation
  • Pharmacy
  • Physician Administrative Services

The direct patient care cost centers have expanded to now include:

  • Nurse Practitioner
  • Registered Nurse
  • LPN/LVNs

The non-reimbursable cost centers have expanded with the following new cost centers:

  • Hospice/Palliative Medicine Fellow
  • Palliative Care Program
  • Other Physician Services
  • Residential Care
  • Advertising
  • Telehealth/Telemonitoring
  • Thrift Store
  • Nursing Facility Room and Board

While there are multiple new cost centers in the hospice cost report, the biggest change is that there is no longer just one line for nursing care. The former nursing care line has been expanded, and nursing costs now need to be reported by both level of care and type of provider (nurse practitioner, registered nurse, licensed practical nurse, licensed vocational nurse).

Level of Care

The biggest single change within the new cost report is the addition of worksheets A-1, A-2, A-3 and A-4. These worksheets require that direct patient care costs be recorded by level of care for each cost center. As previously noted, worksheet A-1 is for continuous home care costs, worksheet A-2 is for routine home care costs, worksheet A-3 is for inpatient respite costs, and worksheet A-4 is for general inpatient costs. Additionally, when completing the revenue section of worksheet F-2 for the income statement, the revenue must be recorded and reported by both level of care and by payer.

Worksheet B and B1 - Ready for New Allocations

Several new cost centers require a statistical allocation. The new statistical bases are as follows:

  • Capital Related Building & Fixtures - Square Feet
  • Capital Related Movable Equipment - Dollar Value
  • Employee Benefits - Gross Salaries
  • Admin & General - Accumulated Costs
  • Plant, Operations & Maintenance - Square Feet
  • Laundry & Linen - In-Facility Days
  • Housekeeping - Square Feet
  • Dietary - In-Facility Days
  • Nursing Administration - Direct Nursing Hours
  • Routine Medical Supplies - Patient Days
  • Medical Records - Patient Days
  • Staff Transportation - Mileage
  • Volunteer Services Coordinator - Hours of Service
  • Pharmacy - Charges
  • Physician Administrative Services - Patient Days
  • Other General Services - Specify Basis
  • Patient/Residential - In-Facility Days

Worksheet C - A Better Cost Analysis

Once the cost report is completed, you will have a better way of measuring your cost per diem. The former Worksheet D has changed to become Worksheet C, and there are now 5 calculated cost per diems. The cost per diems are:

  • Continuous Home Care Cost per Day
  • Routine Home Care Cost per Day
  • Inpatient Respite Care Cost per Day
  • General Inpatient Care Cost per Day
  • Average Cost per Day

The new calculations for cost per day resolve one of the initiatives brought forth in the Affordable Care Act. One of the goals was to gather more information so that appropriate payment reform can be made based on more accurate information.

General Ledger Expansion

Be prepared to expand your current general ledger chart of accounts. This expansion is almost required to be able to accurately report the direct patient care service costs by level of care, which is mandatory for the new hospice cost report. Properly setting up the new general ledger will be most helpful for completing the new worksheets A-1, A-2, A-3, A-4 and F-2. Remember, these are the new worksheets that the direct patient care salaries and other costs must be entered on from the trial balance.

Similarly, when expanding the general ledger chart of accounts, be sure to include the gross revenue – and record it by both payer and level of care. This detail is needed when completing the revenue section of worksheet F-2.

How to Proceed

First, the education of your staff is important. The clinical staff will need to understand the new challenges of having to keep the additional details. Once you get the buy-in from your staff, they will be instrumental in properly reporting the new requirements, and completion of the new cost report will be made much easier.

Second, an overhaul and expansion of the general ledger chart of accounts is needed to capture the costs by level of care. The key areas to be aware of include salaries, staff transportation, contracted services, DME/oxygen, and non-routine medical supplies.

Finally, be sure to assess your information technology systems to determine if you are using them to full capacity. Many times, hospice organizations may not be taking advantage of the system capabilities they already have, or may be able to make system modifications or upgrades to meet the new hospice cost report requirements more efficiently.




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