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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

NAHC, MACs Issue Informational Resources on Hospice CR8877

September 24, 2014 11:08 AM

Since issuance of Change Request 8877(CR 8877), Hospice Manual Update for Diagnosis Reporting and Filing Hospice Notice of Election (NOE) and Termination or Revocation of Election, hospice providers have raised numerous questions to which National Association for Home Care & Hospice (NAHC) staff have sought answers from the Centers for Medicare & Medicaid Services (CMS) and Medicare’s Administrative Contractors (MACs). 

Following is a series of Questions & Answers that NAHC has compiled for use by hospice members.  Below the Q & A section there are links to CMS and MAC resources currently available relative to CR8877. 

This Q & A document will be loaded on the NAHC website in the near future. 



Please note: The responses provided to the questions below were developed with use of the Centers for Medicare and Medicaid Services (CMS) Change Request (CR) 8877, as well as other official CMS correspondence and publications such as hospice manuals. For some of the questions we have included the direct response that was provided from CMS – these are referenced as “CMS Response” to minimize confusion.


Question:  What is the effective date of CR 8877?

Answer:  CR 8877, Hospice Manual Update for Diagnosis Reporting and Filing Hospice Notice of Election (NOE) and Termination or Revocation of Election, is effective for all hospice claims with dates of service October 1, 2014 and later. (Clarified by CMS September 2014)



Question:  How does the hospice know the NOE has been accepted by the Medicare Administrative Contractor (MAC)?

Answer:  The practical meaning of ‘submitted to and accepted by the Medicare contractor’ is that the NOE/NOTR was not returned to the provider for correction. Providers can determine this most quickly in the negative – no NOEs/NOTRs among their RTP’d records.  They can determine it positively after the NOE is processed by CWF when they see the beneficiary’s hospice benefit period information changed. (Provided by CMS August 2014)

NOTE: A hospice billing error can create an untimely NOE and no payment.  This is because some of the reasons for the NOE not being accepted may not be identified for several days after submission.  It is imperative that hospices ensure the NOE does not have billing errors. Given the limited time frame allowed for “timely” submission, it is advisable that hospices check for RTPs on a regular basis.


Question:Must the hospice submit an NOE it knows it will have to back out at a later date (i.e. when a previous hospice still has an open election)?

Answer: CMS is looking into possible future system enhancements to reduce the number of scenarios under which information must be backed out in the first place. (Provided by CMS September 2014)

Yes, the hospice should still submit the NOE.  The hospice will need to use the KX modifier to request an exception. 


Question:  When an NOE has to be corrected after it has initially been filed and accepted (i.e. election date incorrect, diagnosis code incorrect, attending physician incorrect, etc.) will the initial filing date be the date used to determine compliance with the 5-day timely filing requirement?

Answer:  CMS needs to research this with the system maintainer. (Provided by CMS September 2014)


Question:  In the case of a transfer patient, does the system allow an 8xC to be filed by the receiving hospice before the prior hospice submits their final claim?  If not, what process should be followed with the NOE (8xC) when the patient is a transfer? 

Answer:  Yes, the 8xC is allowed in this case.  If a hospice encounters the situation where it is not accepted, it should report the example of the error to the MAC so they can report the problem to [the CMS] system maintainer. (Provided by CMS September 2014)


Question:  Can the NOE be sent to the MAC electronically?

Answer:  No, the MACs cannot accept the NOE electronically.  It must be entered via DDE or mailed to the MAC.  This is per the FISS Manual; however, the Medicare Claims Processing Manual, Chapter 11, states the MACs can receive it via messenger as well as DDE or mail.  We are awaiting responses from all the MACs regarding what address to mail the NOE to should that be necessary as well as confirmation or denial of whether they can accept an NOE that has been sent via messenger, and if so, to what address it should be delivered.


Question:  Can you clarify if the liable days that a hospice is responsible for due to late filing of NOE should in fact still be listed as line items on the claim per existing billing/formatting requirements but that they would simply report the charges associated with those line items in the non-covered charges column?

Answer:All service lines should be reported as usual but any line item dates within the occurrence span code 77 period should be reported with non-covered charges.


Question:  What fields are required to be completed on the NOE?

Answer:  The Medicare Claims Processing Manual, Chapter 11, is a helpful reference.  We caution providers that there may be MAC-specific requirements for the NOE.  Please see the RESOURCES section at the end of this document for links to MAC-specific information. 



Question:  Is there a certain type of bill for the NOTR like there is for the NOE (type 8XA)?

Answer:  Yes, bill type 8xB is the NOTR.  When the CR was first released some hospices tested submission of the 8xB to their MAC and it failed.  We understand that as of the end of September 2014 all MAC systems have the capability of receiving the 8xB via DDE or mail (it cannot be sent electronically). 


Question:  Some providers understand that filing an 8xB (NOTR) will prohibit them from being able to file a claim at a later date.  Is this accurate and will the system be modified to allow claim submission after an 8xB has processed?

Answer:  This is not correct.   If a hospice encounters this situation, they should report the example of the error to their MAC so they can report the problem to the system maintainer. (Provided by CMS September 2014)


Question:  What fields are required to be completed on the NOTR?

Answer:  The Medicare Claims Processing Manual, Chapter 11, is a helpful reference.  We caution providers that there may be MAC-specific requirements for the NOTR.  Please see the RESOURCES section at the end of this document for links to MAC-specific information. 



Question:  When we submit a claim with the KX modifier for the exception request, will we receive an ADR on this claim?

Answer:  Providers will receive a request for additional documentation, i.e. a non-medical ADR or ADR, when a claim with the KX modifier is submitted.  Information obtained from the non-medical ADR will be used to determine if the exception will be granted. 


Question:  What is the status of the MACs being able to accept comments on the claim instead of requesting additional documentation on exception requests?

 Answer:  The use of claim ‘Remarks’, which would only apply to re-processing situations, is a local process so you would need to confirm that with each MAC. (Provided by CMS September 2014)



Question: Which diagnosis codes would result in a hospice claim being returned to the provider?

Answer:  Please see Attachment A of CR 8877 for a list of some codes that will result in a hospice claim being RTP’d.  In addition to this list, note that any code on the list in the Medicare Code Editor (MCE) classified as “manifestations” (latest version is v. 31-0, Oct. 2013) will also result in the hospice claim being RTP’d.  Specific codes that will result in claims being RTP’d are:

  • Debility (799.3 and 780.79)
  • Adult failure to thrive (783.7)
  • Various dementia codes in the range of 290.0 through 290.9, 293 and 310.

Please see the RESOURCES section below for links to CR 8877, Attachment A and the proper reference version of the MCE.



PLEASE NOTE: NAHC and HAA caution providers that some processes related to the NOE(and possibly the NOTR) may be MAC-SPECIFIC – this means that it is very important that you seek out instructions from your assigned MAC to be certain that you are following the proper procedure.

Medicare Claims Processing Manual, Chapter 11

CMS CR 8877


Medicare Code Editor, v. 31-0, Oct. 2013




Canceling a hospice notice of election or benefit period

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Canceling a hospice notice of election or benefit period, click here.




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