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National Association for Home Care & Hospice
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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

Heath 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

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

Hospice Cost Report Update

CMS Addresses Use of Square Feet for Capital-related Movable Equipment Costs; NAHC Submits Comments on HHA-based Hospice Cost Report Changes
November 5, 2015 10:03 AM

The Centers for Medicare & Medicaid Services (CMS) is in the process of expanding hospice cost reporting requirements to gather greater detail on costs by level of care. The National Association for Home Care & Hospice (NAHC) has been monitoring activity in this area and submitting recommendations to CMS through the review and comment process. The revised hospice cost report for freestanding hospice providers became effective for cost reporting years beginning on/after October 1, 2014, while the SNF-based hospice cost report changes are effective for cost reporting years beginning on/after October 1, 2015. It is anticipated that the hospital and home health-based hospice cost report changes will likely become effective for cost reporting years starting on/after October 1, 2015 but neither has been finalized as yet.

An ongoing concern of hospice providers related to the hospice cost report revisions is that CMS now requires use of dollar value for purposes of allocating capital-related movable equipment costs while historically hospices have used square feet for this calculation. Many commenters on the hospice cost report changes (including NAHC) urged continued allowance of use of square feet, but CMS responded that use of dollar value is more accurate. In recent months members of NAHC’s Home Care & Hospice Financial Managers Association (HHFMA) have reported submission of requests to the Medicare Administrative Contractors (MACs) for permission to use square feet as an alternative statistic for allocating capital-related movable equipment costs. Two of the MACs have been approving the alternative statistic, while Palmetto GBA has denied the requests.

Ted Cuppett of The Health Group has been issuing educational notices to hospice providers related to hospice cost reporting issues and, as part of one of those notices, outlined his and other firm’s experiences with the MACs related to requests for use of alternative statistics related to allocation of capital-related movable equipment costs. One of those notices caught the attention of a CMS official, who has clarified that IF A HOSPICE PREVIOUSLY USED square feet for this statistic that the hospice is permitted to continue to use that statistic and that a special request for use of alternative statistics IS NOT NECESSARY.

NAHC received the following confirmation from CMS on this issue: 

If a hospice was previously using square feet for allocating capital related movable equipment, a new approval is not necessary or required. We modified the forms but the statistical basis approvals, whether they were through a formal approval, or obtained through no response by the MAC, do not require a new approval process. There was no question posed in the comment period that described an existing basis and the requirement to obtain approval to continue using the existing basis. I understand that many hospice providers used square feet. If they were using square feet prior to October 1, 2014, they may continue to use square feet.

In related news, NAHC and its affiliated HHFMA and Hospice Association of America (HAA) recently submitted comments on proposed changes to cost reporting requirements that affect home health-based hospice organizations. NAHC’s comments included many comments that were previously submitted related to the freestanding and hospital-based hospice cost report changes. A copy of the comments is available here. As part of the comments, NAHC requested that CMS provide more explicit clarification on use of square feet vs. dollar value for allocation of capital-related movable equipment costs. Following are some of NAHC’s comments on this issue:

Capital Related Costs/ Movable Equipment: For hospice Capital Related Costs/Movable Equipment, the home health cost report changes provide inconsistent guidance on the appropriate statistic that should be used. On Worksheet B-1, Capital Related Costs/Movable Equipment is allocated based on EITHER square footage or dollar value (column 2). The costs allocated to Worksheet B/line 25/column 2, will flow to Worksheet O-5/ line 2/ column 2. This cost will then flow to Worksheet O-6 and follow the Medicare step-down methodology. The statistic on Worksheet O-6/ Part II/column 2 is dollar value. The inconsistency between the specified allowable statistics will make it impossible for Worksheet O-6 to be properly prepared.  It should be noted that the home health section of the cost report uses square feet as the reporting statistic for allocation of Capital Related Costs/Movable Equipment.  Given these circumstances, use of square feet is most appropriate for this statistic.

We would also point out that, based on a recent clarification from CMS staff, it is our understanding that any hospice that previously used square feet as the statistic for allocation of capital-related movable equipment costs is permitted to continue to use square feet without the need to request use of an alternative statistic from the Medicare Administrative Contractor (MAC). While we recognize that dollar value may be a more accurate statistic, we support this clarification of policy because most hospices have historically used square feet for this statistic and because it allows for consistent reporting of Capital Related Costs/Movable Equipment between a provider-based hospice and its parent company since hospitals, home health agencies, and skilled nursing facilities continue to use square feet for this statistic.

We recommend that:

  • CMS formalize the clarification so that there is more universal understanding that continued use of square feet is permitted for all types of hospices without the need to request permission to use an alternative statistic from the MAC if that is the statistic that has been used previously;
  • CMS clarify whether new hospice providers would be expected to use dollar value for this statistic; and
  • CMS permit new provider-based hospices to use square feet for this statistic without the need to request use of an alternative statistic if the parent uses square feet for this statistic. This will ensure consistency with the statistic used by the parent provider throughout the cost report.



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