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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

NAHC Comments on FY2016 Hospice Proposed Payment Rule

July 2, 2015 09:50 AM

On April 30, 2015, the Centers for Medicare & Medicaid Services (CMS) issued its proposed rule governing payment and policy changes for the 2016 fiscal year beginning October 1, 2015. The proposed rule contains numerous policy changes in the hospice arena as described here. The National Association for Home Care & Hospice (NAHC) submitted comments and recommendations on the proposal earlier this week.

NAHC’s comment letter to CMS includes general comments on the rule, specific policy concerns and suggestions related to the proposed payment and quality changes, and makes recommendations related to implementation of the proposed changes. NAHC notes at the start of its letter that a particular concern in analyzing the proposed payment changes is that CMS has not released the technical report that reflects information about the proposed payment reforms for hospice; failure to release the report has made it more challenging to assess alternative payment changes. For this reason, NAHC has urged CMS to release the technical report as soon as possible so that the hospice community has more information related to the decisions that CMS made on payment reform.

PAYMENT REFORM. As part of the proposed rule, CMS provided additional data about patterns of care and spending inside and outside of the hospice benefit while patients are on hospice care. NAHC notes that a hospice’s deliberate failure to cover items and services that are part of the hospice bundle is inappropriate and should be addressed through enforcement mechanisms. However, NAHC also notes that problems with the timeliness of data on hospice elections posting to the Common Working File (CWF) has contributed to inadvertent spending outside of the hospice benefit. Further, NAHC comments that CMS’ systems issues have created significant financial losses and operational burdens with respect to the timely filing requirements for the hospice Notice of Election (NOE) and Notice of Termination/Revocation (NOTR) that went into effect in October 2014. NAHC urges CMS to take steps to mitigate the negative impact of the NOE/NOTR timely filing requirements and, over the longer term, to overhaul data systems to allow for more timely processing of beneficiary status. NAHC also cautions CMS against any “blanket determination that all care provided to patients on hospice is the responsibility of the hospice” -- a patient’s right to care outside of hospice for conditions that are not related to the terminal prognosis must be preserved.

Relative to CMS’ proposed two-tiered payment system for routine home care (RHC), NAHC notes that the Medicare Payment Advisory Commission (MedPAC) has estimated that it takes 21 days for a hospice to “break even” on the provision of care after a patient first elects hospice care. NAHC requests that CMS provide information about how the changes to the RHC rates will impact the timing on when a hospice might generally expect to “break even” relative to payment for services. NAHC also urges CMS to conduct ongoing analysis of the adequacy of the payment changes with particular attention to the overall impact on hospices that provide care predominantly to patients with shorter lengths of stay. NAHC also expresses concerns about the inadequacy of CMS’ data systems and their limited ability to provide accurate information related to a patient’s history of hospice use as this will contribute to ongoing challenges for hospices in determining the appropriate payment rates and planning financially for patients coming onto service.

In its letter, NAHC expresses strong opposition to CMS’ proposal to not permit Service Intensity Add-on payments when such services are provided to patients residing in nursing facilities or skilled nursing facilities. NAHC notes that “a prohibition against coverage of SIA services based on a patient’s residence creates unfair and negative incentives that could limit equal access to service for extremely vulnerable patients.” NAHC also urges CMS to reconsider its decision to limit SIA payment only to services provided by Registered Nurses (RNs) and Social Workers. NAHC believes that this add-on should also be permitted for services provided by Licensed Practical Nurses (LPNs)/Licensed Vocational Nurses (LVNs). NAHC also urges CMS to collect data on chaplain visits and in future rulemaking to consider extension of the SIA payment to chaplain services, as well, and to conduct study of resource intensity for patients that transfer from one hospice to another or are readmitted late in an episode of care to determine whether an SIA policy should be instituted in such cases to help cover the high costs at the beginning of care that might be associated with patients being readmitted onto service. Finally, NAHC urges ongoing analysis of the extent to which care cots in the last seven days of life are adequately compensated under the new payment structure.

NAHC addresses numerous implementation issues as part of its comments; of particular concern is whether the new RHC rates would apply to new admissions or to all patients on service; NAHC recommends that the payment rates be implemented for new admissions onto care. Additionally, NAHC expresses concern that there may not be sufficient time between release of the final hospice payment rule and the beginning of the 2016 fiscal year and suggests that CMS only implement the new payment system after it has completed all of the required systems changes and allowed for a “dry run” to ensure a smooth transition.

HOSPICE QUALITY REPORTING. NAHC expresses support for most of the changes that CMS is proposing as part of the quality reporting section of the rule. However, NAHC does caution against use of claims data-based measures (which CMS has identified as a priority area for future measures) unless CMS can ensure that measures can be directly linked to quality of care.

DIAGNOSES ON CLAIMS. NAHC expresses concern that CMS is issuing as a clarification a directive to hospice providers that they should be including all diagnoses on claims -- whether related or not related to the terminal prognosis. This clarification is at odds with a clarification issued last year that instructed hospices to include only related diagnoses on hospice claims. NAHC cautions that sufficient time should be allowed before CMS undertakes any monitoring or enforcement action relative to diagnoses on claims as systems changes will be required to ensure that all diagnoses can flow to the claim, but also raises questions about CMS’ future intent relative to this clarification.

A final rule on the FY2016 hospice payment and quality changes will be issued some time later this summer; NAHC will report on CMS’ disposition of the issues mentioned above and other items discussed in the proposed rule at that time. NAHC’s comment letter on the proposed hospice payment rule is available here.




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