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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

Brady Anti-fraud Bill Addresses Drug Prescribing Issues for Hospices; Audit and Education Reform and DME F2F Modifications

December 9, 2014 01:23 PM

In recent weeks, the House Ways and Means Health Subcommittee Chairman Kevin Brady (R-TX) and Ranking Member Jim McDermott (D-WA) introduced the Protecting the Integrity of Medicare Act (PIMA) (H.R. 5780). The bill includes a provision that would impose a home health surety bond of not less than $50,000 that is “commensurate with the volume of payments to the home health agency.”  

The bill also contains several provisions that would affect hospices and how they may administer certain controlled substances. While it appears that the legislation will not see action prior to the end of this legislative session, it may be a starting point for discussions early next year.  Below is a synopsis of those issues:

Part D Enrollees at Risk for Abuse of Opioids, Other Pain Meds would have Limits on Prescribers, Pharmacies for these Drugs, with Exemption for Hospice Enrollees

As part of H.R. 5780, Rep. Brady and his colleagues seek to address concerns about potential “drug seeking” as part of the Medicare program through establishment of a drug management program for at-risk beneficiaries starting January 1, 2017.  Under the program, Part D enrollees determined to be at-risk for prescription drug abuse could be limited to one or more physicians and one or more pharmacies for certain opioids and similar drugs.  Once a beneficiary has been determined to be not at risk, he or she will be removed from the drug management program. 

Part D plans will be expected to notify at-risk beneficiaries prior to their inclusion in the drug management program and to honor a beneficiary’s request regarding preferred pharmacy(ies) and provider(s), to the extent feasible.  The legislation includes an exemption for Medicare hospice enrollees and other individuals as determined by the Secretary of Health and Human Services.    It is important to note that while Medicare hospice patients will not be subject to enrollment in the drug management program, non-hospice patients (including those that receive Medicare services under a provider’s palliative care program) are not exempted as a class of individuals.  An across-the-board exemption for palliative care patients would not be possible under Medicare since the program does not cover “palliative care” as a type of services.  

NPI as Identifier for Part D Prescribers

Also included in the legislation is a provision that would require that CMS use the National Prescriber Identifiers (NPIs) as the only allowed prescriber identifier for the Medicare prescription drug program; in order for a prescription order to process under Part D, the prescription would be required to include a valid prescriber NPI.  This provision would be effective for the 2016 Part D plan year. 

It should be noted that under existing regulations CMS is requiring that, effective December 1, 2015, prescriptions may not be processed under the Medicare Part D program if the prescriber is not either:

  • Enrolled in Medicare in an approved status; or
  • Have a valid record of opting out

For additional information on this requirement, please see the following NAHC Report storyand Medlearn Mattersarticle.

H.R. 5780 also contains several other provisions that could affect both home care and hospice providers:

Audit and Education Reform

PIMA proposes to try to reduce claim errors through education, outreach, and provider supports. Originally, the sponsors intended to include reforms solely directed towards Recovery Audit Contractors (RACs) in an attempt to bring some transparency to the RAC audit process. As the bill developed, the focus shifted towards ways to reduce claim errors in the first place. It does not focus on any particular sector - as would have occurred with a RAC-directed approach that would have not had much impact in hospice or home health services.

NAHC had asked the sponsors for a broader focus that was designed as a preventative type measure as well.

Entitled as “Improper Payment Outreach and Education Program,” the bill proposes to reduce improper payments by requiring that each Medicare Administrative Contractor (MAC) establish an improper payment outreach and education program under which the contractor, through outreach, education, training, and technical assistance or other activities, provides detailed information about types of payment errors and how to avoid them.

Specifically, the contractors would be required to provide:

  • A list of the providers' or suppliers' most frequent and expensive payment errors over the last quarter.
  • Specific instructions regarding how to correct or avoid such errors in the future.
  • A notice of new topics that have been approved by the Secretary for audits conducted by RACs under section 1893(h).
  • Specific instructions to prevent future issues related to such new audits.

The final bill retains a focus on RACs to an extent, with requirements on the disclosure of information and data to Medicare administrative contractors to assist in carrying out their provider education requirements. The RACs would share data with other Medicare contractors - such as the identities of providers of services and suppliers that have the highest rate of improper payments, the greatest total dollar amounts of improper payments, the highest rates of improper payments, and the items and services that are responsible for the greatest amount of improper payments.

In discussions with Ways and Means Committee staff, NAHC was invited to continue a dialogue focused on reforms of non-RAC contractors that have been more involved in home health services and hospice claims audits.

DME Face-to-Face Physician Encounters

The bill proposes to expand the types of practitioners qualified to perform face-to-face encounters to support the certification of need for durable medical equipment to include Nurse Practitioners, Physician Assistants, and other non-physician practitioners. This change would establish standards comparable to those applied in the home health services face-to-face encounter requirements. However, hospice face-to-face encounters still require either a physician or a nurse practitioner.  

If bill amendments are permitted with this legislation, NAHC will be pushing for expanding the authorization on non-physician practitioners to the hospice face-to-face encounter requirements.

An Update on the Surety Bond Proposal

Earlier this week, NAHC was informed that the PIMA bill, including the home health surety bond proposal, will not be brought up for a vote this year, meaning that NAHC and home health advocates can continue to make the case against imposing a surety bond requirement on all home health agencies, as well as to advocate for other issues addressed in this article. While there are some positive provisions contained in this legislation, there is now an opportunity to try modify the legislation prior to it being reintroduced next year during the new Congress.  

To send a message through the NAHC Legislative Action Network opposing the home health surety bond proposal, click here: Write your Legislators. 

For more on this legislation, please see NAHC Report, December 5, 2014.




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