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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

Heath 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

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

CMS Issues Home Health Coverage Manual Updates

May 7, 2015 02:08 PM

The Centers for Medicare & Medicaid Services issued Change Request (CR) 9119, which updates the Medicare Benefit Policy Manual, chapter 7, relating the requirements for physician certification and recertification. This CR also updates the timeframe required for therapy functional reassessments. All of the new provisions in the manual were discussed in the 2015 HH PPS Final Rule published on November 6, 2014. However, the CR leaves questions for providers regarding CMS’ expectation for implementing some of the new provisions. The National Association for Home Care & Hospice (NAHC) is seeking answers from CMS.

CMS reiterates it has eliminated the narrative requirement from the face to face (F2F) encounter document. However, the certifying physician is still required to certify that a F2F patient encounter occurred. The encounter document must include the date of the encounter, be related to the primary reason the patient requires home health services, and performed by an allowed provider type.

In the manual revision, CMS affirms a new requirement for documentation that was stated in the 2015 HH PPS Final Rule. When the patient is admitted to home health directly after discharge from an acute/post-acute care setting and the physician that cared for the patient in that setting is the certifying physician, but will not be following the patient after discharge, the certifying physician must identify the community physician who will be following the patient. CMS claims the addition documentation is needed in order for the certifying physician to meet the requirement that the patient be under the care of a physician. NAHC is seeking clarification from CMS regarding whether there is specific a format or location within the medical record this information must be located.

CMS maintains its policy thatthe certification must be completed prior to the home health agency bills Medicare; however, they also reiterate that it is not acceptable for HHAs to wait until the end of a 60-day episode of care to obtain a completed certification/recertification. CMS does not address   good faith efforts made by the agency to obtain the certification and what the implications are for agencies if they are not able to obtain the certification until the “end” the episode.

The certifying physician’s medical record and/or the acute/post-acute care facility’s medical records (if the patient was directly admitted to home health) is to be used as the basis for certification of patient eligibility. CMS includes in the manual update a provision from the Final Rule that permits the agency to provide the certifying physician with information from their assessment of the patient, for which the physician would sign and incorporate into his/her medical record. This information may be used to support the patient’s eligibility for home health services. However, the information must be corroborated by other medical record entries in the certifying physician’s and/or the acute/post-acute care facility’s medical record for the patient.

Included in the manual update, which was also stated in the Final Rule, is the requirement from the regulation at §424.22 (b)(2) for home health recertification. The regulation states the physician’s “recertification statement must indicate the continuing need for services and estimate how much longer the services will be required”. This requirement has been in the regulation for many years but has never been incorporated into the Medicare manual. CMS’ policy for this portion of the regulation is stated in the manual as follows:

The physician must include an estimate of how much longer the skilled services will be required and must certify (attest) that:

  • The home health services are or were needed because the patient is or was confined to the home as defined in §30.1;
  • The patient needs or needed skilled nursing services on an intermittent basis (other than solely venipuncture for the purposes of obtaining a blood sample), or physical therapy, or speech-language pathology services; or continues to need occupational therapy after the need for skilled nursing care, physical therapy, or speech-language pathology services ceased. Where a patient’s sole skilled service need is for skilled oversight of unskilled services (management and evaluation of the care plan as defined in §, the physician must include a brief narrative describing the clinical justification of this need as part of the recertification, or as a signed addendum to the recertification;
  • A plan of care has been established and is periodically reviewed by a physician; and
  • The services are or were furnished while the patient is or was under the care of a physician. Medicare does not limit the number of continuous episode recertifications for beneficiaries who continue

Therefore, it is unclear whether the estimated duration for services can be stated as a physician order or must it be included in the recertification statement. NAHC is seeking clarification on this issue as well.  

Finally, CMS updates the manual to reflect the change in policy for the therapy function reassessments timeframes to at least every 30 day, eliminating the 13/19th therapy visit threshold reassessments.  

NAHC has expressed to CMS that agencies are genuinely trying to ensure they have adequate processes in place to comply with the F2F requirement.  However, confusion and concerns remain surrounding CMS’ expectations. NAHC continues to seek clarification from CMS on the home health certification and recertification requirements.

Click here to view CR 9119




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