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Testimonials

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. 

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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.

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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

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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 element...it’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

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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.

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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.

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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.

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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.

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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.

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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.

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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. 

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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.

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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.

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Frank E. Moss, former U.S. Senator

Anyone working on health care issues in Congress knows the name Val J. Halamandaris.

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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.

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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.

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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.

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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.

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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.

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Former President Bill Clinton

Hospice Cap Roundup: Self Calculation and Reporting (2015), the Sequester, and 2013 Cap Determinations

March 10, 2015 09:32 AM

On March 3, the Centers for Medicare & Medicaid Services (CMS) released to the Medicare Administrative Contractors (MACs) the pro-forma spreadsheet and instructions for use by hospices in self-calculating and reporting their aggregate cap.  Beginning with cap year 2014, hospices are required to self-calculate and report their aggregate cap on an annual basis within five months of the end of the cap year (March 31).  Failure by hospices to submit an aggregate cap self-calculation on a timely basis - by March 31, 2015 - and address any related overpayment will result in payment suspension.  It should be noted that the hospice self-calculation will represent an initial cap determination – since hospice patients may continue on service past the cap year end, CMS will require the MACs to make a final cap determination at a later date that could represent an additional cap-related overpayment liability for the 2014 cap year. 

Since release of the spreadsheet and instructions, the Home Health and Hospice MACs (CGS, National Government Services, and Palmetto GBA) have begun to release information for use by hospice organizations in fulfilling their cap reporting requirement.  While the cap calculation pro-forma spreadsheet and instructions were developed by CMS, hospices are encouraged to use the spreadsheet and instructions issued by their assigned MAC as these instructions may include MAC-specific information, such as information related to where and how the hospice’s self-calculated cap should be submitted to the MAC. 

Following are links to MAC-specific information that has been issued, along with any items of particular note:

NATIONAL GOVERNMENT SERVICES (NGS)

Hospice Cap: Self-Reporting Instructions.  Hospices are urged to thoroughly read the instructions for computing the self-calculated aggregate cap prior to completing the spreadsheet.  NGS plans to issue a confirmation of receipt letter within 45 days of receiving a hospice’s self-calculated cap; where applicable the confirmation letter will also serve as an overpayment demand letter.  NGS also intends to conduct a cursory review of a hospice’s self-calculation within 60 days of receipt.  NGS’ instructions note that Illinois hospice providers will NOT submit hospice cap self-determinations to NGS; further, New York hospice providers should follow instructions specific to NGS’ J6 providers. 

PS&R data:  Due to concerns related to some hospice providers being unable to access the PS&R data needed to complete the cap self-calculation report, NGS has indicated that it will consider PS&R data requests on a case-by-case basis.  These requests may be submitted via email to PSR@anthem.com or by calling Lisa Beatty at 414-459-5503.  PLEASE NOTE:  A PREVIOUS EMAIL ADDRESS PROVIDED TO NAHC FOR USE BY HOSPICES IN REQUESTING PS&R DATA (PS&R@ANTHEM.COM) WAS INCORRECT – we regret any inconvenience this has caused and encourage providers who submitted requests to this address to RESUBMIT the request to NGS.

Following are NGS-specific instructions for submitting the pro-forma spreadsheet and any associated repayment:

Submitting the Pro-Forma

Hospice providers should submit the pro-forma calculation along with supporting documentation and a copy of submitted check (if applicable) to NGS no later than March 31, 2015. Providers are able to submit their determinations via email, mail or fax. Please submit the self-reported hospice cap pro-forma calculation and supporting documentation to one of the following:

J6 Hospice Providers

Email: selfreportedhospicecap@anthem.com

NGSConnex

U.S Mail:
National Government Services, Inc.
Reimbursement Department
6775 W. Washington St.
Milwaukee, WI 53214

Fax: 414-459-5081; Attn: Mario Berkec

JK Hospice Providers

Email: JKHospiceCaps@anthem.com

NGSConnex

U.S. Mail:
National Government Services, Inc.
Reimbursement Department - Hospice Cap
5000 Brittonfield Parkway, Suite 100
East Syracuse, NY 13057

Courier Delivery (FedEx/UPS):
National Government Services, Inc.
Reimbursement Department - Hospice Cap
P.O. Box 4900
Syracuse, NY 13221-4900

Fax: -315-442-4256; Attn: Casey Smith


Repaying an Overpayment

If the Self-Report Calculation indicates an amount due Medicare; please make a check payable to NGS and submit it in a separate envelope to one of the following locations:

J6 Wisconsin Providers
(WI, MI, MN, NJ, NY, Puerto Rico, Virgin Islands)

National Government Services
00450 WI Part A Non-MSP
P.O. Box 809199
Chicago, IL 60680-9199

J6 California Providers
(AK, AZ, CA, HI, ID, NV, OR, WA, American Samoa, Guam, North Mariana Islands)

National Government Services
00454 CA Part A Non-MSP
P.O. Box 809311
Chicago, IL 60680-9311

JK RHHI Providers
(ME, MA, NH, VT, RI, CT)

National Government Services
14011 ME MA RI Part A
P.O. Box 809086
Chicago, IL 60680-9086

PALMETTO GBA

Self-Determined Hospice Cap Calculation.   Palmetto’s instructions indicate that only the pro-forma spreadsheet must be submitted (backup calculations need not be provided).

PS&R data:  Due to concerns about access to PS&R data by some hospices, in late February Palmetto mailed the data from the PS&R reports that are needed to complete the pro-forma spreadsheet to hospice providers under its jurisdiction. 

Palmetto also provides the following instructions about timing and submission of the spreadsheet:
When to send?

  • The 2014 Provider Self- Determined Aggregate Cap Limitation is due on March 31, 2015
  • If the completed form is not filed timely, a past due letter will be sent within seven days and  payments will be suspended
  • If unable to file the form timely, a written request can be submitted prior to the due date to request a 50 percent payment suspension
  • If an overpayment is computed and the amount due is not submitted, payments will be withheld

How to send?

The form can be sent by mail, email, or fax. (Only send by one method!)

•       Mail to:

U.S. Postal Service
Palmetto GBA
Attn: Hospice Cap Reporting 
Mail Code: AG-330
PO Box 100144
Columbia, SC 29202-3144 

Courier Service
Palmetto GBA
Attn: Hospice Cap Reporting 
Mail Code: AG-330
2300 Springdale Drive, Building One
Camden, SC 29020-1728


Email to Beth.Burton@palmettogba.com
(Ensure the attached form is a scanned copy and includes the signature.)

Fax to Attn: Hospice Cap Reporting at (803) 935-0262

CGS

Hospice Self-Determined Aggregate Cap and Hospice Caps web page.  CGS plans to conduct a cursory review of pro-forma spreadsheets that have been submitted and will issue a confirmation of receipt letter within 45 days.  CGS also notes that if the self-determined cap is not received within seven days of the March 31, 2015 due date, a Past Due letter will be issued and payments will be suspended.

PS&R data:  In its notice, CGS indicates that it will not supply copies of the PS&R data reports needed to complete the pro-forma spreadsheet to hospices under its jurisdiction.  However, CGS does indicate that hospices that are unable to obtain this information may contact Tom Bisbee, at 515-471-7478 for assistance.

Submitting Cap Determinations

Hospices should send their completed “Provider Self-Determined Aggregate Cap Limitation”  form along with a cover letter and all supporting documents to the following address:

PART A/HHH AUDIT & REIMBURSEMENT
CGS ADMINISTRATORS, LLC
PO BOX 20015
NASHVILLE, TN 37202

Cap Overpayments

Any overpayment amount calculated as a result of the self-determined cap should be sent, along with a cover letter that explains what the payment is for, to the following address:

CGS
P.O. Box 957124
St. Louis, MO 63195-7124

Checks must be made payable to CGS.
If the overpayment is not submitted at the same time as the self-determined aggregate cap, CGS shall demand the overpayment reported on the self-determined aggregate cap.

SPECIAL NOTE ON 2013 AGGREGATE CAP CALCULATIONS

The MACs are responsible for issuing 2013 aggregate cap determinations to hospice providers.  While some of the MACs began to issue 2013 cap determination letters last year, issuance was suspended when CMS determined that additional consideration must be given to how the 2% sequester (which was put into effect in April 2013) would be factored into the aggregate cap determination.  CMS recently resolved how it would incorporate the sequester into the cap liability determination, and it is anticipated that soon after the 2014 cap reporting process has been concluded the MACs will move forward with issuance of  2013 cap determinations.  

HOSPICES SHOULD NOTE THAT IF A PREVIOUS CAP DETERMINATION FOR 2013 WAS ISSUED, THE HOSPICE MAY BE SUBJECT TO A REVISED DETERMINATION OF ITS CAP LIABILITY.  One of the MACs (CGS) that had already issued a number of 2013 aggregate cap determinations to providers under its jurisdiction has issued notification of how it plans to proceed with 2013 cap determinations; that information is now available on the CGS website at:  Sequestration — Impact on Hospice Aggregate Cap Calculations.  CGS indicates that within the five months starting March 3, 2015, it will recompute the 2013 cap calculations and, where a new cap-related liability emerges or a cap liability increases, CGS will issue a Notice of Reopening related to the cap determination and issue a demand for the corrected overpayment. 

 

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