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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

House Proposes Community Integration Act of 2014

October 6, 2014 01:57 PM

On September 18, Rep. Matt Cartwright (D-PA) introduced the Community Integration Act of 2014 (H.R. 5547) in the House of Representatives. This follows Sen. Tom Harkin (D-IA) introducing the same bill, S. 2515, in the Senate on June 24. The Act aims to strengthen Medicaid beneficiaries’ opportunities to receive home and community-based services (HCBS). The National Council on Medicaid Home Care – a NAHC affiliate - discusses the bill’s key provisions below.

Access to HCBS. The Act seeks to amend the Social Security Act to give Medicaid beneficiaries “the choice and opportunity” to receive institutional-level of care in a “home and community-based setting.” The Act stipulates that this choice and opportunity should be “equal” to institutional settings by ensuring that care in home and community-based settings “is widely available on a statewide basis” for those in all states.

Definition of Home and Community-Based Setting. The Act defines a home and community-based setting as, among other things, including “public or private housing where the individual resides” that ensures privacy, maximizes autonomy, and is integrated into the community. This definition largely mirrors that of the Centers for Medicare & Medicaid Services’ (CMS’) recent HCBS rule issued this January. For the Act’s full definition of home and community-based setting, see pages 5-6, here.

For a previous Council brief on the HCBS rule, click here.

Prohibitions of Public Entities. According to the Act, any public entity that receives payment under a state plan or waiver cannot:

  • “Impose or utilize policies, practices, or procedures” that would:
    • Restrict the availability of HCBS to those with disabilities;
    • Limit HCBS “based on the specific disability of an otherwise eligible individual”;
    • “Arbitrarily restrict” a disabled individual “from full and meaningful participation in life”;
    • “Unnecessarily delay or restrict” HCBS services to those requiring them;
  • Fail to implement “adequate payment structures to maintain a sufficient workforce” to provide HCBS to all that are eligible; and
  • Limit access to information on HCBS, either to those currently institutionalized, or those that are about to be institutionalized.

For complete details on the prohibitions of public entities, see pages 7-9, here.

For full details on applications to waiver, see pages 12-13, here.

Enforcement of the Prohibitions. The federal government reserves the right to reduce the federal matching assistance percentage (FMAP) to any state that violates these prohibitions. See page 10, here.

Housing. The Act also mandates that, 180 days after the Act is enacted, states should develop plans to increase housing for those with disabilities. CMS had excluded room and board from the state plan benefit in its recent HCBS rule.


Reducing unnecessary institutionalization. On September 19, the American Bar Association (ABA) issued a letter to Rep. Cartwright indicating its support for H.R. 5547. In its letter, the ABA states that this Act “will reduce unnecessary institutionalization and enable many individuals to live independently and attain full integration into their communities.” The Council echoes the ABA’s sentiment, and believes that this bill is promising in reducing unnecessary institutionalization, while encouraging HCBS utilization.

Mandatory HCBS benefit. The ABA, in its letter, also calls for HCBS to become a mandatory Medicaid benefit for those qualifying for intuitional-level long term care. The Council also supports establishing Medicaid home care as a mandatory benefit. For details, see 21-23 of our 2014 Policy blueprint, here. The Council sees this Act as a positive step in both making HCBS a mandatory Medicaid benefit, and encouraging states to embrace broader coverage of HCBS under Medicaid generally.

Unanswered questions. The Act, while promising, leaves several questions unanswered. It does not specify a funding mechanism for the additional access to HCBS. It does not delineate Medicare and Medicaid’s role in providing the additional HCBS. The Act also does not address to what additional standards, if any, managed care organizations will be held to in providing sufficient access to HCBS.

The Council also looks forward to further clarification on what states are expected to do to implement “adequate payment structures to maintain a sufficient workforce” to provide HCBS to all that are eligible. For example, the Council supports overtime requirements for Medicaid home care workers so long as the overtime is adequately funded by the Medicaid program itself.

While the political climate leading up to mid-term elections makes it unlikely that the Community Integration Act of 2014 will become law during this Congress, it is well poised to be picked up in its current form for passage in the next Congress. The Council encourages its members and the Forum of State Associations to advocate for the Act as it removes barriers to HCBS, and moves HCBS closer to parity with institutional care in Medicaid. The Council will continue to monitor developments of the Act. Members should contact the Council with any questions or concerns.




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