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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 Files Brief in F2F Lawsuit; Court Hearing on August 6

August 4, 2015 04:05 PM

The National Association for Home Care & Hospice (NAHC) filed its closing brief in the lawsuit challenging the Medicare rule that required physicians to compose a narrative following the patient face-to-face encounter to explain why the individual met the homebound and skilled care need elements of the Medicare home health services benefit. The now-rescinded narrative requirement triggered tens of thousands of claim denials based on Medicare contractors claiming that the narrative statements were insufficient to support the physician certification that the patient was homebound and in need of skilled care.  

Within weeks of NAHC’s lawsuit filing, the Centers for Medicare and Medicaid Services (CMS) dropped the narrative requirement from its rule. However, home health agencies nationwide were left with significant claim denials and financial losses stemming from the inconsistent and irrational administration of an unmanageable documentation standard. NAHC continues to litigate the validity of the narrative requirement to address an estimated $150-200 million in claim denials along with the risk that claims prior to the 2015 rescission of the rule could still be audited.

In its brief, NAHC argues that the plain language of the Affordable Care Act provision requiring a physician face-to-face encounter prohibits CMS from imposing the narrative requirement. In the alternative, the NAHC brief argues that the narrative requirement is an arbitrary and capricious rule in that it does not have a rational basis generally or in the context of the Medicare program as a whole. CMS has insisted throughout the litigation that it has the discretionary authority to require a physician narrative and that its implementation of such was reasonable.

At the core of the recent NAHC brief is the argument that CMS’s claim of discretionary authority is merited only if the word, “document,” is taken out of context of the F2F provision as a whole. In other words, CMS argues that it can disregard the full language of the statutory provision and rely solely on its power to define a single word within a sentence. NAHC argues that under such an approach to statutory interpretation, every word of every law is potentially subject to a federal agency interpreting that word inconsistently with the meaning intended by Congress as virtually all words in the English language can have multiple interpretations. NAHC argues that the word in the context of the sentence as a whole gets its proper meaning.

In this case, the law passed by Congress provides that the physician must document that the encounter occurred within the permitted timeframe. By isolating the word “document” from that provision as a whole, CMS argues it can require certifying physicians to document why the patient is homebound and in need of skilled care as the word “document” can mean “why” as well as “what.” In response, NAHC argues that the sentence as a whole focuses the physician’s documentation responsibility solely on when the encounter occurred. Further, if the word document includes a focus on “why,” then the physician would be documenting why the encounter occurred on a particular date, not on why the patient is homebound and in need of skilled care.

NAHC further argues that the CMS requirement is irrational in that it results in an outcome that is the opposite of what Congress intended. It is readily apparent that Congress enacted the face-to-face encounter requirement as a program integrity measure to protect against Medicare paying for services provided to individuals who are not homebound and in need of skilled care. However, with CMS’s implementation of the requirement, homebound patients in need of skilled care have been denied Medicare coverage because a claims reviewer did not accept the sufficiency of the physician’s narrative. NAHC argues that Congress did not intend for Medicare to deny benefits because of a physician’s grammar, sentence structure, or choice of words in the narrative. NAHC argues that the whole patient record should control the coverage decision, not a small part of it such as the physician narrative.

The CMS position is based on a reliance on case law that provides that a federal agency has the right to issue interpretive rules provided those rules are not inconsistent with the plain language of the law passed by Congress or an arbitrary and capricious interpretation of that language. Courts have routinely held that a federal agency’s interpretation is entitled to deference and that, even if that interpretation is not the best one, it will be upheld unless it clearly violates the law.

Evidence in litigation in this type of case is confined to the regulation’s Administrative Record, i.e. the information CMS had at its disposal at the time the rule was developed. Within the Administrative Record are the public comments submitted on the proposed rule. NAHC’s brief argues that there is no evidence in the 5291 pages of that record to support the imposition of the narrative requirement. In fact, there is not even a single submitted comment that agreed with CMS that the narrative requirement made any sense. Instead, the record is populated by hundreds of comments that explain to CMS that its proposed narrative requirement would be totally unmanageable and problematic. As it turned out, CMS finally recognized the validity of those comments in 2014 and rescinded the narrative requirement.

The case is scheduled for oral argument before U.S. District Judge Christopher R. Cooper on August 6, 2015 at 10AM. A ruling is expected shortly after that hearing. NAHC is seeking relief that includes an invalidation of the narrative requirement from its inception, an injunction to prevent any further claims reviews applying the narrative requirement, a reopening of all narrative-based claim denials since January 1, 2011, and a payment on any past denied claims.




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