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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 Instructions for Medical Review on Home Health Certifications

July 22, 2015 12:50 PM

The Centers for Medicare & Medicaid Services (CMS ) released Transmittal 602; Change Request (CR) 9189, which provides medical review instructions on the certification and recertification requirements for  home health services.

The CR instructs reviewers that the physician’s entire medical record should be reviewed to determine if the eligibility criteria for home health services have been met. The physician’s record must include information that supports all the required elements for certification including the need for skilled service, reason for homebound, and a valid face to face (F2F) encounter. The CR affirms that documentation from the home health agency (HHA) can be incorporated into the physician’s record and is to be considered when determining eligibility for home health services:

“…..            the patient’s medical record must support the certification of eligibility. Documentation in the patient’s medical record shall be used as a basis for certification of home health eligibility. Therefore, reviewers will consider HHA documentation if it is incorporated into the patient’s medical record held by the certifying physician and/or the acute/post-acute care facility’s medical records (if the patient was directly admitted to home health) and signed off by the certifying physician. The documentation does not need to be on a special form.”

Any documentation from the HHA that is incorporated into the physician’s record must corroborate the physician’s medical record for the patient and be “signed off” by the physician in a timely manner.  

“The reviewer shall consider all documentation from the HHA that has been signed off in a timely manner and incorporated into the physician/hospital record when making its coverage determination. HHA documentation that is used to support the home health certification is considered to be incorporated timely when it is signed off prior to or at the time of claim submission.”

The CR contains an inconsistent definition for “incorporated timely.” Business Section- 9189.4 of the CR states that timely incorporation is when the documentation is “signed off” prior to or at the time of certification. However, in the body of the CR under section 6.2.3, it reads that “incorporated timely” is when the documentation is “signed off” prior to or at the time of claim submission. CMS has clarified for the National Association for Home Care & Hospice (NAHC) that timely incorporation is prior to or at the time of claim submission. CMS will revise the Business Requirement section to reflect section 6.2.3.

CMS will require that the initial certification requirements be met in order for subsequent episodes to be covered, regardless of whether the requirements for recertification are met. Therefore, agencies will be required to submit documentation from physician’s record for the initial certification for home health services for any claim that is reviewed.

According to the CR, if the review contractor finds that the documentation in the certifying physician’s medical record, including the HHAs incorporated documentation, is insufficient to demonstrate the patient is or was eligible to receive services under the Medicare home health benefit, payment on the home health claim will be denied. 

CMS, in the CR, also states  the requirements for recertification and reiterates that a recertification for home health services must include a statement by the certifying physician which indicates a continuing need for services and estimate how much longer the services will be required. NAHC was hopeful that CMS would allow the duration for services as ordered by the physician to meet this requirement. However, it is apparent from the CR that CMS intends to require a statement from the physician in addition to orders for visit frequency and duration.

Several of the Medicare contractors have instructed agencies that the physician should estimate how much longer services will be needed for the entire spell of illness for the patient. Therefore, the estimated time frame could be stated longer than the 60 day recertification period. Since this is a physician’s estimate, the agency must obtain the information from the physician, but it can be an oral communication. CMS does not provide instructions to reviewers on how or where this statement needs to be located. The CR only states that “The contractor shall review for the certifying physician statement which must indicate the continuing need for services and estimate how much longer the services will be required.” NAHC recommends that agencies either incorporate a statement within the certification statement for recertification or include a separate statement in the medical documentation where it is obvious to the reviewer, such as on the plan of care.

However the agency chooses to address this, it should be clear that it is part of the certification for continued services. If using a statement separate from the certification statement, NAHC recommends that agencies phrase the physician’s estimation for services as a certification statement. For example: “I certify that in my estimation continued services will be required for _______.” A statement for the estimation of services is required for each recertification regardless of how long the physician expects home health services will be needed.

NAHC also recommends that agencies provide as much information as possible to the certifying physician to be incorporated into his/her medical record. At a minimum, agencies should provide the certifying physician with the POC and pertinent sections from the comprehensive assessment, along with an admission summary of the why the patient is in need of skilled services and is homebound. Agencies should also confirm that a face-to-face encounter has occurred within the required time frame. (See previous NAHC Report article on this topic here).

NAHC is concerned that CMS will be making initial coverage determinations based solely on the certification requirements contained in the physician’s record, similar to when the narrative was required for the F2F encounter requirement. CMS will not likely make determinations for reasonable and necessary care based on the agency’s medical record unless the certification requirements have been met. 

Click hereto view the CR.




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