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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

Hospice Self-Calculation of Aggregate Cap -- Meet March 31 Deadline or Payments will be Suspended

March 21, 2015 09:42 AM

The National Association for Home Care & Hospice (NAHC) has made a concerted effort to keep hospice providers apprised of issues related to a new Centers for Medicare & Medicaid Services (CMS) requirement for hospices to self-calculate and report their aggregate cap status to their assigned Medicare Administrative Contractor (MAC) within five months following the close of the cap year, beginning with the 2014 cap year. Hospices are also required to pay back or make payment arrangements for any liability within this same time frame. Timely implementation of the cap reporting requirement has faced several challenges; as a result there is some confusion among hospice providers about the applicability of the requirement and how to meet it on a timely basis. Due to a variety of questions and concerns fielded in recent weeks by members of NAHC’s hospice team, this article provides answers to frequently-asked questions related to the hospice cap reporting requirement and supplies information (some of which has been reported previously) on how providers can meet the requirement.


WHO MUST COMPLY?  ALL Medicare-participating hospice providers must self-calculate their 2014 hospice aggregate cap and report it to their assigned MAC BY MARCH 31, 2015. Failure to submit the cap calculation by the deadline will result in payment suspension. Hospices will be required to submit aggregate cap calculations on an annual basis from here on out.


The PROVIDER SELF-DETERMINED AGGREGATE CAP LIMITATION spreadsheet that was issued by CMS in early March, as well as the instructions that accompany the spreadsheet. (All of the MACs have posted the spreadsheet and instructions on their websites; it is strongly advised that you use the spreadsheet and instructions issued by your assigned MAC and CLOSELY REVIEW the materials on your MAC website as each MAC may have different requirements relative to submission of documents related to the cap calculation and its submission )

From the PS&R:
The Provider-Summary Report with PAID DATES THRU January 31, 2015 or later, and
The Hospice Beneficiary Count Summary (either Streamlined of Fully Pro-Rated depending on which is applicable to your hospice)

HOW DO I KNOW IF MY HOSPICE IS STREAMLINED OR FULLY PRO-RATED?  From 1983 until 2011, all hospices were on the streamlined beneficiary counting method. In 2011, CMS created the pro-rated (or proportional) method for counting beneficiaries in response to a number of cap liability appeals that challenged use of the streamlined method.  Hospices were permitted to “elect” the proportional method for the 2011 cap year if they chose to do so. In 2012, unless a hospice requested that it be kept on the streamlined method, it was transitioned to the pro-rated beneficiary count method. All new hospices automatically were placed on the pro-rated method. As a result, the majority of hospice providers are likely on the pro-rated method. However, you cannot assume that your hospice is on the pro-rated method. Your cap determination letter from your MAC that was issued for the 2012 cap year may state what beneficiary counting method you are under. If you are uncertain what method you are under and can find no documentation of it, you will need to seek that information from your MAC.

WHAT IF I CANNOT ACCESS THE PS&R REPORT?  In order to access the PS&R, providers need to go through a CMS software system, IACS. At the beginning of 2015, CMS began phasing out IACS and moving to a new software system, EIDM. Some providers were not in “active status” in the IACS system when CMS began to transition the PS&R to a different system, EIDM (starting Jan. 31, 2015) and have not been able to register as the transition has been postponed and no new registrations may be submitted. A hospice in this situation must obtain the PS&R information from their MAC. NOTE:  Palmetto sent copies of the PS&R reports to all hospices under its jurisdictions; both CGS and NGS will provide reports to hospices that are unable to secure them if the hospice requests it.

WILL THE MAC-SUPPLIED PS&R REPORTS PROVIDE INFORMATION ABOUT WHAT BENEFICIARY COUNTING METHOD MY HOSPICE IS UNDER? The PS&R report supplied by the MAC (Hospice Beneficiary Count Summary) may specify either “Streamlined” or “Fully Pro-Rated”. If not, all Beneficiary Count Summary reports contain a “Beneficiary Identification Period” line - on the top right side of the page. If your Beneficiary Identification Period begins with 9/28/13, you are on the Streamlined method. If your Beneficiary Identification Period begins with 11/01/13, you are on the Proportional or Fully Pro-Rated method.

MY HOSPICE IS UNDER CAP, BUT WHEN I PUT THE REQUIRED INFORMATION IN THE SPREADSHEET, I COME UP WITH A POSITIVE VALUE IN LINE 5 -- DO I REALLY OWE MONEY TO MEDICARE?  CMS made every effort to keep the self-calculation spreadsheet as simple as possible. However, it is important that providers first read the accompanying instructions as they provide important information about the cap calculation. CMS has indicated if the value that you arrive at in line 5 is positive, you should put a ZERO in line 5, which then indicates that your hospice has no cap-related liability.

NOW THAT I HAVE COMPLETED MY CAP CALCULATION FOR 2014, DOES THAT “CLOSE” THE 2014 CAP YEAR?  The self-calculation of the aggregate cap represents an interim assessment of a hospice’s cap liability. A hospice that calculates a liability owed to CMS must pay that liability by March 31, 2015, or make arrangements for payment at that time. Information regarding making arrangements for payment can be obtained from your MAC. At some time in the future (likely some months in the future) your assigned MAC will conduct an assessment based on more recent data related to your beneficiary count for the 2014 cap year and will issue a final cap determination notice. The MAC’s final cap determination calculation will also take the 2% sequester into account.  A hospice’s cap liability may change between its self-calculation and the MAC’s final cap determination for the cap year, in which case the hospice is obligated to pay any additional liability owed.

Following are links to information that is available on the MAC websites related to self-calculation of the hospice cap:

CGS: Hospice CapInstructions for completing the Pro-Forma for Provider Self-Determination of Aggregate Cap Limitation

NGS: Hospice Cap: Self-Reporting Instructions

Palmetto: Self-Determined Hospice Cap Calculation, Sequestration: Impact on Hospice Aggregate Cap Calculation

Previous NAHC Report hospice cap coverage:

March 10, 2015: Hospice Cap Roundup: Self Calculation and Reporting (2015), the Sequester, and 2013 Cap Determinations

February 4, 2015: An Update on Self-Reporting of Aggregate Cap for Hospices




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