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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

MedPAC Issues FY2016 Hospice Recommendations, Provides Key Policy Commentary

March 20, 2015 08:58 AM

Annually the Medicare Payment Advisory Commission (MedPAC) issues a Report to Congress in March that contains a series of recommendations on payment policy changes it advises for the forthcoming payment year.  As part of the 2015 Report’s chapter on Hospice Services, the Commission examines adequacy of current hospice payments, provides a wealth of updated statistics on benefit utilization, and advocates for payment and policy changes based on its findings. 

For 2015, MedPAC projects an aggregate Medicare margin for hospices of 6.6 percent.  This statistic was arrived at by taking into consideration the following factors:

  • The 2012 margin estimate;
  • Market basket updates of 2.6, 2.5 and 2.9 for fiscal years 2013, 2014, and 2015, respectively;
  • A market basket reduction of 1.0 percentage point in 2013, 0.8 percentage point in 2014, and 0.8 percentage point in 2015 (the productivity adjustment and additional annual 0.3 percentage point adjustment, both required under the Affordable Care Act);
  • A 2.0 percent reduction in payments due to the sequester, starting in April 2013;
  • The budget neutrality adjustment factor (BNAF) reduction impact for 2013, 2014, and 2015;
  • Additional wage index change; and
  • Assumption of higher cost growth in 2014 and 2015 due to increased regulatory burdens.

As anticipated and reported previously, MedPAC’s 2015 Report includes the following recommendations relative to hospice services:

  • Elimination of the update to the hospice payment rates for Fiscal Year 2016;
  • Reaffirms a 2014 recommendation that hospice should be included as part of the Medicare Advantage benefit package, beginning in 2016;
  • Reprints its 2009 recommendation that Congress should direct HHS to change the Medicare hospice payment system to provide relatively higher payments per day at the beginning of the episode and relatively lower payments per day as the length of the episode increases; include relatively higher payments for costs associated with patient death at the end of the episode; and implement the changes in 2013, with a brief transitional period.  The payment changes should be budget neutral in the first year.
  • Reprints its 2009 recommendation that Congress should require HHS to implement a face-to-face encounter requirement, performed by a hospice physician or advanced practice nurse, in advance of the 180th day recertification and all subsequent recertifications, with an attestation requirement; require that certifications and recertifications include a brief narrative describing the clinical basis for the patient’s prognosis; and require that all stays in excess of 180-days be medically reviewed for hospices in cases where a hospice’s stays exceeding 180 days make up 40 percent or more of their total cases.

The hospice chapter for 2015 has been updated to include a synopsis of the Institute of Medicine’s (IoM) recent recommendations on care at the end of life, incorporates data analysis conducted by the Centers for Medicare & Medicaid Services (CMS) and its contractors on hospice payment reform, and responds to recommendations made by the Office of the Inspector General (OIG) as part of a recent report on hospice services provided to residents of assisted living facilities (ALFs).   MedPAC expresses support for some of the OIG’s recommendations relative to use of claims data-based measures, including:

  • Potential use of high live discharge rates as a quality indicator or for use as a “transparency” measure;
  • Potential use of measures  that convey whether skilled visits were provided by the hospice in the last few days of life for value-based purchasing or as a “transparency” measure (MedPAC plans to explore appropriate ways of crafting this type of measure in future work); and
  • Potential use of whether the hospice makes care at the General Inpatient, Continuous or Inpatient Respite levels available when needed as a public reporting measure (MedPAC indicates that large providers that fail to provide all four levels of care may merit immediate scrutiny).

Hospice stakeholders are encouraged to review the MedPAC hospice chapter as it contains a wealth of useful information and data relative to industry trends.




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