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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

Sustainable Growth Rate Legislation Includes Two-Year Extension of Rural Add-on

March 24, 2015 03:29 PM

The U.S. House of Representatives this Thursday will consider legislation on the floor to permanently repeal the Sustainable Growth Rate (SGR).  The National Association for Home Care & Hospice (NAHC) has learned that this legislation will include a two-year extension of the Medicare Home Health Rural add-on at its current 3% level, which is set to expire at the end of this year.

As previously reported, the Rural Add-on extension has been one of NAHC’s top priorities for the SGR bill and it would be a huge victory for home care. However, the SGR legislation—as currently drafted—also includes some problematic provisions for home care and hospice, including a reduction in the annual inflation update and imposition of a surety bond on home health. In addition to keeping the rural add-on extension language in the bill, NAHC is working to mitigate the payment cut and remove the surety bond requirement from the legislation.

The legislation will extend the current 3 percent payment rate add-on for home health services delivered to residents of rural areas.  This is exactly what NAHC recommended to Congress in its Legislative Blueprint for Action. Loss of the add-on would likely result in agencies having to turn away patients and even eliminate services in rural areas. The delivery of care in rural areas generally costs more than it does in urban areas due to a number of factors. Rural agencies endure fixed costs with fewer patients and visits, resulting in higher per-patient and per-visit costs. Rural agencies also tend to lack access to capital for technological advances that can improve efficiency. MedPAC has consistently found that rural agencies have profit margins below those of urban agencies. For those reasons and more, rural home health services have had a payment differential in one form or another for most of the last 25 years.

An important element of the rural add-on extension is that the bill does not include any “offset” whereby home health care itself is forced to pay for the cost of the add-on. It is estimated that the add-on cost for two years exceeds $200 million. NAHC had been prepared to cover that cost with adjustments to outlier episode funding, but it appears that is now unnecessary. 

While inclusion of the Rural add-on is good news, the legislation would also impose a harmful surety bond requirement on home health agencies. NAHC has argued against similar proposals to impose a surety bond in legislation and in the President’s budget. Currently, Medicare has the authority to impose a surety bond on home health agencies but has chosen not to do so. The legislative change would make the surety bond a mandatory condition of participation in Medicare for all home health agencies. Further, it would require that a bond be no less than $50,000 in value with the authority to scale the bond amount to much higher levels based upon the Medicare revenue in the home health agency. 

With the SGR bill going to the House Rules Committee on Wednesday, NAHC is taking the opportunity to try to eliminate the surety bond requirement. The fate of the requirement lies in the hands of Congressman Jim McDermott of Washington State (D-WA-7) who is the ranking member of the House Ways and Means Subcommittee on Health. This week, Washington State home health agency representatives are meeting with their congressional delegation in hopes of convincing Congressman McDermott to withdraw the provision. NAHC and the Washington State members have enlisted the support of Senator Patty Murray (D-WA) to encourage the Congressman to drop it.

NAHC learned that the Congressional Budget Office determined that the bond requirement would bring only $10 million in Medicare savings over 10 years. The bonds are estimated to cost $130 million over that same 10 years. The small savings is indicative of the fact that virtually all Medicare overpayments are fully repaid by home health agencies.

Reach out to your member of Congress to reject the surety proposal through the NAHC Legislative Action Center by clicking here.

The SGR bill also includes a hardwired 1% inflation update for all post-acute care and hospice providers in 2018. That preset update includes a rescission of the annual productivity adjustment leading to a rate reduction likely equivalent to 1 point. That estimated rate reduction is derived as follows: estimated 2018 Market Basket Index (2.5%) minus Productivity Adjustment (0.5%) equals 2.0%; 2% update minus 1% update cap equals a 1 point reduction. 

NAHC continues in its efforts to stop that cut for both home health agencies as well as hospices. However, NAHC is also prepared to present alternative reforms that could achieve comparable savings in Medicare spending. There are indications that the House intends to present such an opportunity later this year. Part of the House plan in setting a rate cut date of 2018 is to provide the opportunity for health care sectors to develop substitute reforms.

At this stage, the SGR bill does not include relief from the burdensome face-to-face physician encounter requirements. NAHC has had extensive discussions with members of Congress and their staff on necessary F2F reforms, but no agreement was reached on the nature and substance of those reforms. NAHC wants changes that will significantly address the documentation requirements, the criteria for qualifying a physician to perform the face-to-face encounter, the use of telehealth services as the means to the encounter, and exceptions to the requirements overall. Work continues in that direction.

If the House ultimately passes the SGR bill, its fate in the Senate is uncertain. There are indications that the Senate may pass the bill, however there remains concern with certain issues such as the extension of the Medicaid children’s health program. Senate home care allies are positioning their support for home care related improvements if that opportunity surfaces. It is also likely that a very short-term patch bill arises to give physicians temporary relief, while giving the Senate some time to consider the complexities of the bill. The Senate is scheduled to leave for recess on Thursday so time is extremely limited.

Stay tuned to NAHC Report and NAHC Alerts for emerging developments. Reach out to your members of Congress through the NAHC Legislative Action Center by clicking here.




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