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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

CMS to Activate Advance Care Planning Codes

Practitioner payment for CPT codes 99497 and 99498 effective January 1, 2016
November 13, 2015 01:42 PM

On October 30, 2015, the Centers for Medicare & Medicaid Services (CMS) placed on public display the final rule governing  Medicare Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2016, which includes information on payment for advance care planning (ACP).  The Rule is scheduled to be published in the Federal Register on November 16.  Previous NAHC Report coverage on the rule is available here


As part of the final rule, CMS announced its plans to move forward with activation of:

  • CPT code 99497 [Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed) by the physician or other qualified health professional; first 30 minutes, face-to-face with the patient, family member(s) and/or surrogate] ; and
  • An add-on CPT code 99498, [Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health professional; each additional 30 minutes (List separately in addition to code for primary procedure)].

These activities may be billed on the same day or on a different day from billing of other Evaluation and Management (E&M) services, but may not be billed on the same date of service as certain critical care services including neonatal and pediatric critical care.

Following is information provided by CMS in response to numerous comments on the proposal to active the ACP codes beginning January 1, 2016:

Providers of ACP:  While CMS recognizes the role of other providers in the provision of ACP services (such as social workers, chaplains, and others), CMS notes that CPT code descriptors describe services furnished by physician or other qualified professionals, which for Medicare purposes is consistent with allowing these codes to be billed by the physicians and non-physician practitioners (NPPs) whose scope of practice and Medicare benefit category include the services described by the CPT codes and who are authorized to independently bill Medicare for those services. Therefore only these practitioners may report these CPT codes.  As a physician service, CMS notes that “incident to” rules apply when these services are furnished incident to the services of the billing practitioner, which includes a minimum of direct supervision.  CMS expects the billing physician or NPP to manage, participate and meaningfully contribute to the provision of the services.  CMS also notes that the usual PFS payment rules regarding “incident to” services apply, so that all applicable state law and scope of practice requirements must be met in order to bill ACP services.  CMS does not believe it would be appropriate to create an exception to allow these services to be furnished incident to a physician or NPP’s professional services under less than direct supervision.

Relative Value Units (RVUs):  Activation of the codes means that these codes will be separately payable under the Physician Fee Schedule (PFS) and that they are assigned work relative value units (RVUs) of 1.5 (99497) and 1.4 (99498). 

National Coverage Determination:  While CMS will evaluate whether a national coverage determination should be developed for this service, CMS believes that it may be advantageous to allow time for implementation and experience with ACP services before considering such, so for the time being the contractors will be responsible for local coverage decisions. 

Location of Services:  ACP services are appropriately furnished in a variety of settings, and are separately payable to the billing physician or practitioner in both facility and non-facility settings and are not limited to particular physician specialties. CMS has also provided for payment of ACP services to hospitals when such services are provided in an outpatient department under the CY2016 hospital outpatient prospective payment system final rule.

Part of Annual Wellness Visit (AWV):  CMS requested comment in the proposed physician payment rule as to whether ACP services should be billable as part of the AWV.  In the final rule, CMS has added ACP as a voluntary, separately payable element of the AWV.  CMS instructs that when ACP is offered as part of the AWV as part of the same visit on the same date of service and the parameters for billing the ACP CPT codes are met (including the requirements for the duration of the ACP services), the appropriate ACP code(s) should be reported and should be reported with the modifier -33 so that there will be no Part B coinsurance or deductible charged (as is consistent with the AWV).

Training:  Many individuals commenting on the proposal to active the ACP codes recommended that CMS establish standards or require specialized training as a condition of payment for ACP services.  CMS responded that since the ACP CPT codes describe face-to-face services, they don’t believe it is appropriate at this time to apply additional payment standards, but CMS will continue to consider whether such are appropriate.

Beneficiary Cost-sharing:  While a number of commenters recommended that CMS waive beneficiary cost-sharing for ACP services, CMS does not have statutory authority at this time to do so.  CMS does recommend that practitioners inform beneficiaries of the voluntary nature of ACP services and also that ACP service will be subject to separate cost sharing (except as part of the AWV).




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