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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

CMS Issues Revisions to Benefit Policy Manual to Reflect FY2015 Payment Rule Changes

Election Form, Revocation, and Attending Physician Requirements Addressed
April 10, 2015 09:25 AM

The Centers for Medicare & Medicaid Services (CMS) recently issued Transmittal 205/Change Request (CR) 9114, which makes changes to Chapter 9 of the Medicare Benefit Policy Manual to reflect hospice regulatory changes put into effect as part of the fiscal year (FY) 2015 payment rule.  Specifically, CR9114 revises the manual to provide explicit sections related to the notice of election (NOE), hospice revocation, hospice discharge, and hospice notice of termination or revocation (NOTR) (all of which provide greater detail related to hospice requirements in these areas) and also expands the existing section on attending physician services.  These changes are effective May 4, 2015.

The new material, which has been added to the Benefit Policy Manual by way of CR9114, is mostly information that has been supplied by CMS previously in the preamble to the final FY2015 hospice payment rule and in the previously-issued CR8877.  However, it is important to note that CMS has included a new requirement that -- as part of the information identifying the attending physician on the election statement -- the hospice must include the physician’s national provider identifier (NPI) number.  This is a change from the information CMS included in the final FY2015 payment regulations in that the NPI was referenced as a potential item for identifying the attending physician on the election statement but not explicitly requiredThe National Association for Home Care & Hospice (NAHC) has concerns that hospices may not have access to the NPI of the attending physician at the time the election statement is signed and that patients may have some concerns about signing a form with empty spaces on it.  One option may be to include space for the attending’s NPI in a FOR OFFICE USE ONLY box on the form.  NAHC has sought guidance from CMS on this issue, and also as to whether it is appropriate for the hospice to enter the attending physician’s NPI on the form after it has been signed.  We will provide any guidance that we receive from CMS in future publications.  In the meantime, hospices and vendors are advised to modify their election statements to include space for the NPI of the patient’s chosen attending physician, as well as to educate staff and modify processes to ensure that the NPI of the attending physician is secured and entered onto the election statement in time for the May 4, 2015, effective date.   NAHC has also sought additional clarification from CMS regarding requirements related to designation of attending physician for purposes of the hospice benefit and is awaiting response.

Following is a comparison of the existing and revised table of contents.

Changes to Chapter 9 Medicare Benefit Policy Manual
Table of Contents (TOC) under CR 9114

Existing TOC (excerpt)
(Rev. 188, 05-01-14)
Revised TOC
(Rev. 205, Issued: 04-03-15)

20.2 - Election, Revocation, and Change of Hospice

20.2 - Election, Revocation, and Discharge

20.2.1 - Hospice Discharge

20.2.1 – Hospice Election – Hospice Notice of Election

20.2.2 - Hospice Revocation

20.2.3 - Hospice Discharge

20.2.4-Hospice Notice of Termination or Revocation - Attending Physician Services - Attending Physician Services


Following are substantive changes that CMS had included as part of the revisions to the Medicare Benefit Policy Manual and the associated content area.

20.2.1 Hospice Election:  For this section, CMS has identified information previously included in 20.2 Election, Revocation, and Change of Hospice that is applicable to the hospice election.  CMS also includes instruction that the Election Statement must include information identifying the individual’s designated attending physician (with enough detail that the identity of the physician or nurse practitioner (NP) is clear, and must include, at a minimum, the attending’s name and NPI number).  The Election Statement must also include acknowledgement that the designated attending is the individual/representative’s choice. Hospice Notice of Election:  This section outlines the timely filing requirement related to the Notice of Election (NOE), including the exceptional circumstances under which the hospice’s assigned Medicare Administrative Contractor (MAC) may waive the timely filing requirement.

20.2.2 Hospice Revocation:  This section contains information previously included in section 20.2, and no new material has been included.

20.2.3 Hospice Discharge:  This section is, in essence, the same as the previous version that was issued in May 2014.

20.2.4 Hospice Notice of Termination or Revocation (NOTR):  This section manualizes the requirement for timely filing of the NOTR in cases where the hospice does not submit a final claim within the five-day window. Attending Physician Services:This section has been expanded to contain instruction about including identification and acknowledgement of an individual/representative’s choice of attending on the election statement that is filed with the hospice (as referenced in 20.2.1), as well as provides instruction on the appropriate process to follow when a patient or representative wants to change the designated attending physician (which should be addressed by filing a signed statement with the hospice identifying and acknowledging choice of the new attending). Hospices should note:

(1)  CMS is requiring that the chosen attending’s name and NPI be on the election statement that the patient signs

(2) The section also underscores that the effective date of designation of or change in attending physician cannot be earlier than the date that the designation is signed.




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