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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

Homecare Advocate Testifies Before House Energy & Commerce Subcommittee on Health: Hearing Held to Discuss Legislation to Reform the Home Health Face-to-Face Physician Documentation Requirement

October 1, 2015 04:41 PM

The House Energy & Commerce Subcommittee on Health held a hearing on Thursday, October 1, on three bills to improve the Medicare program, including the draft legislation, the Home Health Documentation and Program Improvement Act of 2015, introduced by Congressman Greg Walden (R-OR). The legislation would reform the Centers for Medicare & Medicaid Services (CMS) home health face-to-face encounter documentation requirement by eliminating unnecessary paperwork, refocusing the requirement on patients who may not have a strong relationship with their physicians, and preventing unwarranted claim denials for patients where the overall record demonstrates that the patient meets Medicare coverage standards. The National Association for Home Care & Hospice (NAHC) submitted formal testimony at the hearing in support of Congressman Walden’s proposed legislation.

“NAHC strongly supports the proposed reforms as needed to address the unmanageable rules that have been instituted by the Centers for Medicare and Medicaid Services requiring extensive and unnecessary paperwork from physicians,” NAHC stated in its testimony. “The bill would specifically address the two most important reforms that are needed: the documentation requirements and the unnecessary application of the requirements to patients admitted to home health services following an inpatient stay where multiple physician/patient encounters occur… In addition, it would address the past claim denials that were issued through application of a documentation standard that no one could understand, a standard later abandoned by CMS. NAHC supports each of these necessary reforms.”

Among the hearing witness was Sarah Myers, Executive Director of the Oregon Association for Home Care, who testified about the importance of Congressman Walden’s legislation. “One of the greatest burdens we face today is the implementation of the face-to-face requirement,” she stated. “Fortunately, there is a solution: Congressman Walden is authoring legislation that would establish a simple approach to documenting physicians’ face-to-face encounter with their patients. In place of confusing requirements, this reform would ensure the policy is clearly and logically upheld through physician recording of the date of the encounter and use of a standardized form to identify the clinical condition for which home health is needed.”

In his opening statement, Congressman Walden said that home health in general is “less expensive, more convenient, just as effective as care in a skilled nursing facility,” and that “receiving care at home gives seniors more control over their health care and provides a sense of comfort and familiarity for the patient and for their loved ones.” However, he stated, the “current documentation requirements, associated with the so-called face-to-face requirement, have placed significant pressures on the home health care community and the people they serve.” Congressman Walden further explained the importance of the proposed legislation to reform the requirement. “We have a situation in which a complicated regulatory process simply needs to be streamlined and standardized, and that’s what this legislation would do,” Congressman Walden said. “Mr. Chairman, this isn’t just about a backlog of appeals and red tape; it’s about improving access to, and quality care of, our seniors.”

Support for Congressman Walden’s proposal came from a number of subcommittee members. Congresswoman Susan W. Brooks (R-IN) stated that the face-to-face documentation requirements created by CMS are “complicated and confusing,” leading to “crushing burdens” for home health agencies, creating a “care crisis.” Congressman Ben Ray Lujan (D-NM) was concerned about the impact of the face-to-face documentation requirements on access to care in rural areas of New Mexico where physicians are scarce. Congressman Michael Burgess (R-TX), a physician, recognized the need to combat fraud and abuse but expressed that a Medicare contractor’s denial of a claim because the physician did not do enough paperwork to satisfy the contractor is not what is needed.  

In its submitted testimony, NAHC explained that “the administration of the face-to-face encounter requirement has led to unintended confusion, burdensome paperwork for physicians, increased costs for home health agencies without any material improvement in program integrity, and an endless paper-chase.” NAHC also stated the requirement has been “ineffective” in targeting any waste or abuse in the Medicare program. “An abusive provider has an easier time showing compliance with the requirements through falsified documentation than a home health agency that wants to be fully compliant,” NAHC stated. “Notably, the face-to-face encounter requirements often lead to Medicare rejecting claims for patients who are truly in need of the physician-prescribed skilled care and who meet the benefit’s ‘homebound’ requirement because of a subjective standard of what face-to-face encounter documentation is ‘sufficient’ as that limited documentation supersedes the complete patient record.”

The bill would address these problems through the following reforms: 1. Limit the physician documentation requirement to demonstrating that a timely encounter occurred, consistent with the original intent; and 2. Narrow the circumstances where a face-to-face encounter is required by excluding patients transferred from a hospital or SNF where physician encounters are virtually guaranteed. The bill would also address the thousands of past claim denials by requiring CMS to either reach a settlement with affected home health agencies or reopen and pay those claims denied related to the physician narrative.

While NAHC has advocated that Congress repeal the face-to-face physician encounter provision, NAHC stated that “the reforms proposed in the legislation are a significant improvement over the current requirements and present a manageable middle-ground that maintains the core requirement of a physician face-to-face encounter with the patient while addressing the daunting paperwork burdens that lead to unnecessary problems for qualified Medicare beneficiaries, physicians, home health agencies, and the Medicare program.”

In addition to the reforms contained in the bill, NAHC has stated that full-scale reform should also: provide an exception in areas where physicians are scarce; permit a waiver in a case-specific situation where a face-to-face encounter is not feasible; permit face-to-face encounters by way of an expanded telehealth definition as the standard in the current law is useless as a patient must leave her home to have a telehealth visit with a physician.

In the Senate, similar bipartisan legislation has been introduced by Senators Robert Menendez (D-NJ) and Pat Roberts (R-KS).

NAHC will continue to work with lawmakers in support of advancing the legislation to reform the face-to-face documentation requirement. In addition to seeking a legislative remedy, NAHC continues its legal challenge to the claim denials resulting from the Medicare home health services physician face-to-face narrative requirement. A decision on its lawsuit challenging the validity of the physician narrative requirement is likely any day from the federal court in Washington. You can read more about NAHC’s lawsuit here.




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