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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

More Congressional Support for Rural Add-on Extension

March 31, 2015 09:29 AM

The 3 percent rural add-on payment for home health services is currently set to expire at the end of 2015. Last week, NAHC reported that the House-passed bill to permanently replace the sustainable growth rate (SGR) includes a two-year extension of the 3 percent rural add-on. Subsequently, the Senate adjourned for a two-week recess before voting on the bill. However, Senate leaders have indicated they plan to consider it after returning on April 13. The Senate is expected to pass the legislation, including the rural add-on, with strong support on both sides of the aisle.

Before the House took this action extending the rural add-on for two years, U.S. Senators Susan Collins and Maria Cantwell, last week, introduced S. 839, a bill that would extend the rural add-on for another five years. Senator Collins had previously expressed to NAHC her interest in introducing this bill. The support from these Senators and others in Congress contributed significantly to the inclusion of the two-year extension in the SGR bill.

“I know how important the add-on is for our rural areas – it’s a matter of life and death,” said NAHC’s President Val J. Halamandaris. “To breathe the clean air should not be a death sentence, and our Medicare system should not discriminate based on an accident of birth. I want to thank Senator Collins, along with Senator Cantwell, for championing the rural add-on extension and protecting the ill, aged, and disabled in rural areas.”

The rural add-on used to be higher than 3 percent. From April 2001 to April 2003, the add-on was 10 percent for home health services delivered in rural areas. Congress then reinstated the add-on at 5 percent, until it expired in 2006. It was not until the Patient Protection and Affordable Care Act (PPACA) in 2010 that the rural add-on was reinstated at 3 percent. Under the PPACA, the rural add-on payment became effective for visits from April 1, 2010, through January 1, 2016.

In its Legislative Blueprint for Action, NAHC recommended that Congress should extend the current 3 percent rural add-on. Without the add-on, many agencies would likely be forced to turn away patients and even eliminate services in rural areas, where access to care is a critical issue. As evidence of this, some agencies reported that they had to eliminate delivery of services to remote areas during the period of time, before 2010, when the add-on was unavailable.

It often costs more to deliver care in rural areas than in urban areas. Agencies in rural areas are typically smaller scale operations with fewer patients and visits. Smaller agencies must spread fixed costs over fewer patients and visits, resulting in higher per-patient and per-visit costs. Smaller agencies are also more likely to have a lower volume of patients, meaning they lack access to a varied case-mix. Profitable cases do not always offset the resource-intensive, expensive cases. With an inconsistent census of patients, a smaller agency also faces difficulty retaining full-time staff.

Rural agencies also face more difficulty in hiring staff because they are unable to compete with the wages and benefits that hospitals offer. Furthermore, home health agencies, unlike hospitals, are ineligible for reclassification of their wage index.

Another challenge for rural agencies is they often lack access to capital for technological advancements and efficiency improvements. Not to mention Medicare payment policy does not allow for reimbursement of such technology.

As a result of all of this, rural agencies have had consistently lower profit margins than urban agencies, a fact that MedPAC has confirmed. NAHC projects that by 2017—with the loss of the rural add-on and the continuation of rebasing—fifty-seven percent of rural agencies would be underwater, meaning they would receive less in Medicare payments than their costs.

So it is good news that Congress—with the leadership of individuals like Senators Collins and Cantwell—is demonstrating support for the importance of extending the rural add-on. NAHC is pleased that, additionally, the rural add-on extension in the SGR bill does not include an “offset” requiring home health care to pay for its cost. The cost of a two-year extension is estimated to exceed $200 million. While NAHC has been prepared to cover that cost with adjustments to outlier episode funding, it appears that is now unnecessary. 

NAHC will continue to engage Congress to ensure the current 3 percent add-on is extended. Please contact your members of Congress using NAHC’s Legislative Action Center to extend the rural add-on and cosponsor S. 839, introduced by Senators Collins and Cantwell.




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