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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

MedPAC Outlines Upcoming Report to Congress

September 22, 2014 02:46 PM

The Medicare Payment Advisory Commission met on September 12, 2014 to go over its pending report to Congress regarding the impact of home health payment rebasing on beneficiary access to quality of care. This meeting was the second time MedPAC staff offered an outline of the direction of its report to Congress. That report was mandated as part of the Affordable Care Act changes that included the current rebasing of Medicare payment rates affecting home health agencies.

MedPAC staff presented several key points to the commissioners. These included a positive assessment of the value of home health, expressing that the home health benefit can be a useful tool for keeping beneficiaries out of the hospital. As we have seen frequently in the past, however, MedPAC staff also raised concerns about a history of fraud and abuse in home health. Staff explained that the home health industry had a history of tailoring their services to reflect Medicare payments and that the sector was marked with excessive overpayments brought on by "high" payment rates and unnecessary utilization.

The MedPAC staff also outlined that the supply of home health services has increased over the years despite payment adjustments in the past. They noted that there has been an increase the supply of urban located home health agencies with a slight reduction in the number of agencies located in rural areas. Staff also noted that quality of care continues to show improvement despite payment reductions that occurred over the past 10 years. It is the staffs' opinion that any reduction in the utilization of home health services is not related to payment rate changes, but rather efforts to combat fraud, such as the moratorium on new home health agencies and new regulatory requirement such as the face-to-face encounter rule.

With respect specifically to its report on developments related to rate rebasing, a variety of statistical analyses were presented to the MedPAC commissioners. These included a finding that Medicare margins have averaged over 17% from 2001 through 2012. Also, the staff explained that payment rate reductions in that period of time did not lead to any marked reduction in Medicare margins. Staff posited that increases in case mix weights offset these rate reductions.

However, the data presented did not always paint a rosy picture for home health agencies. While in early years margins stayed steady following rate reductions, MedPAC data also shows a marked decline in margins in 2011 and 2012. Specifically, data from 2010 shows margins for freestanding home health agencies at 19.2%, but dropping to 14.4% in 2012. This data is consistent with the NAHC analysis that demonstrates a trend towards margin reductions that will accelerate during the rebasing of payment rates.

MedPAC data also shows that share of Medicare beneficiaries using home health services increased from 6.2% to 9.6%, a 54% increase. At the same time, episodes per home health user increased from 1.4 to 1.8%, a greater than 30% increase. MedPAC staff considers it most notable that non-post acute episodes account for the majority of the episode growth. At the same time, MedPAC data shows that hospitalization rates have not changed significantly between 2003 and 2012.

In the course of discussion regarding the staff report, commissioners emphasized that home health is a critical component of a well functioning program of integrated care. They further expressed that the primary issue is home health services is not often will integrated with other parts of the delivery system. The commissioners also discussed some of the points that had been made by the home health industry in the past as to why rate rebasing was problematic. The chair of MedPAC, Glenn Hackbarth, indicated that while the home health argues that it needs money to invest in staff, technology, and other capital improvements, high margins indicate that this reinvestment is not happening.


Chairman Hackbarth also dismissed industry arguments that other payers fall far short of costs and that the loss of Medicare revenues would affect a broad base of patients served by agencies who care for Medicaid, Medicare advantage, and traditional Medicare beneficiaries. He expressed that Medicare is not meant to subsidize other payers.

The commissioners also focused on areas for future consideration. Specifically, commissioners are interested in understanding more about the substantial difference in home health care received by those immediately out of the hospital in comparison to those admitted directly from the community. In addition, the commissioners are interested in examining differences between hospital-based and freestanding home health agencies, for-profits and not for profit home health agencies, along with dual eligible patients (Medicare – Medicaid beneficiaries).

While the report to Congress was mandated in the ACA, NAHC is concerned that the MedPAC analysis will be insufficient to fully appreciate the significant rate reduction impact on access to care and the quality of services. MedPAC staff is relying upon data from a time period that precedes the rate rebasing. At the same time, MedPAC staff seems to ignore the emerging trend in financial outcomes triggered by rate reductions. That data shows in 2011 and 2012 that the payment rate cuts are directly affecting the home health industry's bottom line. As such, NAHC expects that the rate reductions in rebasing, along with payment reductions under sequestration and the new productivity adjustment will deteriorate margins to a point where home health agencies struggle to survive.

NAHC has developed a robust analysis regarding financial outcome and is working with its affiliate, the Home Care and Hospice Financial Managers Association, to provide real-time analytics to the current cost/revenue status of home health agencies in the first year of rate rebasing.

Congressional support for rebasing reform continues to grow as concerns regarding the impact of unprecedented rate cuts take hold. Currently, legislation is pending that would rollback rebasing. It is expected that rebasing reform legislation will advance for the first quarter of 2015 as Congress takes up, once again, payments to physicians under Medicare. The so-called "physician fix" legislation can be a vehicle to include Medicare home health legislation as well.

NAHC has learned that MedPAC intends to submit its report to Congress well in advance of the January 1 deadline. That report will be shared with NAHC in draft form prior to its finalization. Nevertheless, it is fully expected that the report will mirror the outline presented to the MedPAC commissioners on September 12. It can be anticipated that the report will recommend that Congress not step back from the rate rebasing it mandated in the ACA in 2010. In fact, it is expected that MedPAC in its March recommendations to Congress will once again recommend the rate rebasing be accelerated and cut deeper into the payment rates.

NAHC encourages its member home health agencies to participate in any data gathering effort that focuses in on real time cost and revenue data. It will be a combination of good data along with solid political support that will gain traction in the industry's efforts to reform rate rebasing.

A central figure in this effort is Sen. Ron Wyden, chairman of the Senate Finance Committee. Senator Wyden will be addressing the NAHC annual meeting on October 19. It is crucial that the industry make its voice heard at that time. Along with Senator Wyden, Senator Rob Portman, a Republican leader regarding Medicare and home health industry issues, will address the NAHC Annual Meeting on Tuesday, October 21. We encourage everyone to join us for the NAHC Annual Meeting and to lend their voices in support of congressional efforts to reform rate rebasing.




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