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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

Heath 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

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

CMS Holds F2F Open Door Forum that Leaves More Questions than Answers

March 17, 2015 04:36 PM

On March 11, the Centers for Medicare & Medicaid Services (CMS) held the second in a series of Open Door Forums (ODF) for the voluntary electronic and paper clinical template for the home health Face to Face (F2F) encounter requirement. On the call were CMS officials from the Provider Compliance Group and the Medical Director for Strategic Health Solutions, a CMS Supplemental Medicare Review Contractor.

The formal portion of the presentation was brief with an overview of the documentation that could be requested for medical review. In addition, CMS presented two schematics as examples of workflows for the F2F encounter documentation. One workflow addressed the example of a community physician seeing a patient; the other addressed the example of a hospitalist conducting the encounter in the hospital.

Lastly, CMS presented its revised electronic and paper templates. The electronic template is an improvement in that it includes more checkboxes, less narrative and has been condensed from five to three pages. However, the paper template went from a combination of checkboxes and narratives to a form that requires all narrative responses. This appears to contradict what participants on the last ODF call clearly expressed—a desire for a paper clinical template that contained more predetermined language with checkboxes.   

The presenter highlighted that, when determining compliance with the F2F encounter, the medical reviewers would look for the physician or practitioner’s documentation of the in-person visit, the need for skilled services, and homebound status in the physician’s record. The presenters did not specifically elaborate on what documentation within the physician’s medical record, such as information from the home health agency’s assessment findings, would be acceptable to support a patient’s eligibility for home health services.

During the question and answer session, several of the participants questioned the presenters about CMS’ policy that allows a physician to sign information from an agency’s assessment and incorporate it into his/her medical record to support eligibility. The CMS representative responded by comparing agency documentation to consultation notes that might be found in a physician’s record, concluding that CMS does not actually consider these documents to be part of the physician’s record, since they are not generated by that physician. CMS indicated it would only look for documentation the physician generated to support home health eligibility.

This interpretation is in conflict with what CMS clearly spelled out in the final rule for home health prospective payment system (HHPPS) rate update.

“…….. it would be permissible for the HHA to communicate with and provide information to the certifying physician about the patient’s homebound status and need for skilled care and for the certifying physician to incorporate this information into his or her medical record for the patient. However, the certifying physician must review and sign off on anything incorporated into his or her medical record for the patient that is used to support his/her certification/re-certification of patient eligibility for the home health benefit. In addition, any information from the HHA (including the comprehensive assessment) that is incorporated into the certifying physician’s and/or the acute/post-acute care facility’s medical record for the patient (if the patient was directly admitted to home health) and used to support the certification of patient eligibility for the home health benefit, must corroborate the certifying physician’s and/or the acute/post-acute care facility’s own documentation/medical record entries, including the diagnoses and the patient’s condition reported on the comprehensive assessment.”

In addition to the stated policy in the final rule, CMS hosted a National Provider Call on the F2F encounter requirement, in which presenters from the Medicare Chronic Care Policy Group provided a documentation example of when it would be acceptable for an agency to provide information from its assessment for the physician to use in conjunction with the physician’s documentation to support home health eligibility.

The following is an excerpt from the transcript of the National Provider Call - Certifying Patients for the Medicare Home Health Benefit on December 16, 2014:

“This section from the home health agency, which has been incorporated into the physician’s record, has been signed and dated by the patient’s physician”…….. “it’s been signed and dated by certifying physician indicating review and incorporation into the patient’s medical record.”

The two together, the section from a comprehensive assessment done by the home health agency and the physician’s discharge summary, corroborate each other. The two fit together.

The discharge summary states that PT is needed to restore the ability to walk without support. And the section from the home health agency’s comprehensive assessment describes the supportive device, a wheeled walker. They both corroborate the patient’s clinical needs and why the patient is homebound.”

In addition to providing conflicting information, the presenters seemed to be unaware that CMS had previously issued other polices related to the F2F encounter. There was also confusion over whether a discharge planner or a physician support staff could compile a discharge summary for the physician to sign and use as the documentation of the F2F encounter, or whether the community physician could only cosign a F2F encounter note from the physician who conducted the encounter in a facility.  

One bright spot on the call was when CMS stated it would allow a physician to document the F2F encounter using an electronic or paper template that included predetermined language with checkboxes. 

The call raised concerns and confusion among the home health industry due to the conflicting information from different groups at CMS. It appears there is inadequate coordination between the policy division and the medical review division.

The National Association for Home Care & Hospice has contacted both the payment policy and the medical review divisions at CMS seeking clarification and guidance. We will keep our members updated as we learn more.




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