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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 Lawsuit Challenging the Medicare Face-to-Face Rule Presented in Court

August 6, 2015 05:01 PM

Counsel for the National Association for Home Care & Hospice (NAHC) presented oral argument before U.S. District Court Judge Christopher Cooper on August 6, 2015, regarding NAHC’s lawsuit challenging the validity of the physician narrative requirement in the physician face-to-face encounter rule. While Medicare rescinded the narrative requirement from its rule after NAHC filed its lawsuit last year, Medicare has not provided nearly $200 million in retroactive payments to home health agencies that were wrongfully denied claims because of the now-rescinded narrative requirement. NAHC brought litigation on the validity of the narrative requirement so that home health agencies that provided care to patients in good faith are paid for their inappropriately disallowed claims.

“We are trying to fix an injustice for the home health agencies that are stuck in limbo with nearly $200 million in unpaid claims because of the now-rescinded narrative requirement,” stated Val J. Halamandaris, President of NAHC. “Medicare rescinded its ill-conceived narrative requirement after we filed this lawsuit last year. However, we are still trying to clean up the mess the narrative requirement left behind—nearly $200 million in wrongful claim denials to home health agencies. These home health agencies provided services to Medicare patients in good faith, and they should receive payment for the nearly $200 million in claims that they were wrongfully denied.”

After months of back and forth legal briefs by NAHC and the Medicare program, the home care community finally had its day in court regarding its lawsuit challenging the validity of the physician narrative requirement in the physician face-to-face encounter rule. The parties presented their oral arguments to U.S. District Judge Christopher Cooper. It was quickly apparent that Judge Cooper was very engaged in the nuances of the litigation and fully cognizant of its importance to Medicare home health care beneficiaries and providers.

The NAHC position was argued by Bill Dombi, Director of NAHC’s Center for Health Care Law. Counsel’s argument focused on the language of the provision in the Affordable Care Act that mandated the physician face-to-face encounter, contending that the plain language requires only that the physician document that the encounter occurred. “The issue is what the whole provision states, not the single word ‘document’ as the Medicare program wishes to be the case,” stated Dombi. That argument was directed to Medicare’s contention that the word “document” is ambiguous and that Medicare has the authority to define ambiguous terms in any reasonable way that it wishes, including a requirement that the physician had to explain, in a narrative, why a patient meets Medicare coverage standards. 

As an alternative, NAHC counsel argued that the narrative requirement was not a reasonable or rational interpretation, as the result of that policy leads Medicare beneficiaries and their providers denied coverage even where the whole record supports coverage. “Congress did not authorize a rejection of a claim based solely on the review of the limited physician narrative, particularly when the full record clearly demonstrates coverage,” he stated. NAHC’s counsel referenced the court to a Medicare determination where the contractor explicitly found that the full record supported a finding that the patient met Medicare homebound and skilled care requirements, but denied it on the basis that the physician’s homebound narrative was insufficient. While Congress intended the face-to-face requirement as a program integrity measure, “Medicare’s implementation triggered the opposite outcome, where bona fide claims were denied based on a reviewer’s rejection of the physician’s choice of words, grammar, or sentence structure,” he stated.

Medicare was represented by Justin Sandberg of the U.S. Department of Justice. Sandberg argued that Medicare has the discretion to interpret the law when it is ambiguous and reasonably did so with the face-to-face encounter law. He emphasized the points made in his written briefs that the word “document” is ambiguous and that the narrative requirement is consistent with congressional intent to address waste, fraud, and abuse.

District Judge Cooper posed numerous well focused questions to both parties. Of particular concern for the judge was whether the challenged rule, on its face, permitted Medicare to deny a home health services claim based solely on the sufficiency of the physician narrative, regardless of what the whole patient record revealed on the patient’s homebound status and skilled care need. While Medicare’s counsel tried to avoid a direct answer, NAHC counsel explained to the court that Medicare’s rule empowered its contractors to issue such claim denials based on that basis alone.  “Such a rule is not reasonable or rational as it leads to absurd results that are morally offensive,” stated NAHC’s counsel.

“We are confident that the judge fully understands the issues and we presented a strong and forceful argument on behalf of the home health care community,” stated Halamandaris. “We will continue this fight as long as it takes to make things right,” Halamandaris added.

There is no timetable for the court to issue its ruling in the case. If a favorable decision is rendered by the judge, Medicare will be required to reopen and pay all the claims rejected in the past on the basis that the face-to-face narrative was insufficient. While NAHC and the home health care community awaits the court’s ruling, NAHC continues to press for congressional relief on the face-to-face encounter requirements including a reversal of past denied claims. “We must employ all options to protect home health agencies from misguided federal rules,” explained Halamandaris. 




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