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National Association for Home Care & Hospice
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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

MedPAC Comments on Proposed Hospice Payment Changes

Opposes CMS’ Plans to Deny SIA for NF/SNF Patients
June 5, 2015 10:15 AM

The Medicare Payment Advisory Commission (MedPAC) has submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the proposed payment reform rule that was issued April 30.  As part of the letter, MedPAC supports CMS’ proposed modifications to the structure of the payment rates for routine home care (RHC) as a “positive step toward better aligning hospice payments with the…pattern of hospice visits throughout an episode.”  Relative to the Service Intensity Add-on (SIA) permitted for RN and Social Worker visits within the last seven days of life, MedPAC “urges CMS to permit these payments for hospice patients in nursing facilities because regardless of setting we would expect hospice patients to have increased needs for nursing support and symptom management in the last days of life.”  The National Association for Home Care & Hospice (NAHC) is in the process of developing comments on the proposed regulation, which are due by 5 p.m. on June 29, but shares MedPAC’s concern about the disallowance of the SIA for patients in nursing facilities or skilled nursing facilities.  The overriding goal of hospice payment reform should be to more appropriately reimburse hospice providers for the cost of delivering needed services rather than to pay them differentially based on the location of the patient’s residence or to discourage the provision of needed services.

MedPAC views CMS’ planned implementation of a higher RHC rate for days 1-60 of care, and a lower rate for day 61 and subsequent days, as a “conservative” but “reasonable initial approach” that is “straightforward to implement and has the effect of increasing payments in the beginning portion of the episode and reducing payments later in the episode.” MedPAC does raise issues as to whether the changes are sufficient to address higher costs related to short-stay patients, but sees the changes as leaving room for finer base rate categories in future years if data indicate they are warranted.  MedPAC does not support lengthening the period of time for which the higher initial RHC rate would be applicable.

MedPAC also expresses support of CMS’ proposed policy that days of care “follow the patient” such that if a patient is discharged alive from hospice care the episode day count continues until after 60 consecutive days of non-hospice care have passed.  MedPAC sees this as necessary to minimize financial incentives for hospice patients to be enrolled and disenrolled, or transferred between hospices.  MedPAC does not support shortening of the time frame (60 days between hospice discharge and the readmission to hospice care) that would trigger a new episode of care and the higher rate for RHC.  MedPAC also comments on the lack of clarity as to how the new payment system will be implemented relative to patients on care at the beginning of the 2016 fiscal year, and suggests that CMS apply the new payment rates for RHC based on the day within the episode of care that the patient is in at the time the new payment rates become effective. 

As mentioned previously in this article, MedPAC expresses concerns about CMS’ plans to exclude patients in the nursing facility setting from eligibility for the SIA payment as -- regardless of setting -- patients will likely have an “increased need for nursing support to manage their symptoms in the last days of life.”  MedPAC suggests that a more appropriate approach to addressing perceived lower costs of providing care in a nursing home would be to adjust the RHC rate for patients in nursing facilities.

MedPAC also comments on CMS’ plan to annually recalibrate budget neutrality between expenditures for RHC and the SIA and supports that action.

In brief comments on CMS’ plans for continuing development of hospice quality measures and in keeping with perspectives presented as part of its March 2015 Report to Congress, MedPAC supports CMS’ expressed intent to develop claims-based quality measures (such as measures based on live discharge rates, skilled visits in the last days of life, and burdensome transitions in and out of hospice), as well support for development of measures that focus on outcomes, including pain.

NAHC will be developing comments on the FY2016 proposed hospice payment rule.  NAHC member agencies, vendors and consultants that have questions or comments they would like to have considered for inclusion in NAHC’s comments on the rule should send them to Theresa Forster at




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