Skip to Main Content
National Association for Home Care & Hospice
Twitter Facebook Pintrest
A A A
Print

Testimonials

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 element...it’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

Hospice Obtains Restraining Order Against CMS For Medicare Administrative Appeal Backlog

November 13, 2015 01:44 PM

A hospice provider in Savannah, Georgia, recently took the government to federal court, challenging the interminable backlog in the Medicare administrative appeals process. Faced with millions of dollars in proposed recoupments that would have forced it out of business, the hospice provider sued the Centers for Medicare and Medicaid Services (CMS) in federal court and obtained a temporary restraining order prohibiting the government from recouping alleged overpayments while the provider pursued its administrative appeal rights. Following an evidentiary hearing on additional injunctive relief, CMS agreed to settle the case and stay recoupment until after the provider’s administrative appeal rights are exhausted.

Like many providers, Hospice Savannah found itself subjected to a Zone Program Integrity Contractor (ZPIC) audit. Despite Hospice Savannah’s stellar, objective performance metrics, the ZPIC sought to impose adjustments on a handful of claims and then use statistics to extrapolate those adjustments across the provider’s universe of claims. Filing administrative appeals, Hospice Savannah challenged the attempted adjustments, as well as the statistical extrapolation, which was based on an untested methodology that has not been peer reviewed by statistical experts.

At the initial levels of the administrative appeal, Hospice Savannah was able to stay the government’s efforts to recoup the alleged overpayment against current Medicare receivables. Unfortunately, at the very step of the appeals process where providers are most successful, the Administrative Law Judge (ALJ) level, CMS’ regulations allow it to begin recoupments. While allowing recoupment may have been reasonable when the laws were enacted and when the ALJs were to issue their decisions within 90 days, the ALJs now have a backlog of claims that could delay a decision for over five years. As with many hospices, Medicare payments represented approximately 80% of the hospice’s overall revenues. Immediate recoupment of 100% of its Medicare payments would have been immediately crippling.

Beyond the harm to the hospice, its patients and employees would have been harmed. Its terminally-ill patients and family members, most of whom are elderly and disabled, would have been particularly adversely affected by the closure. They would need to find new hospice providers and would then need to become acclimated to new caregivers. It was doubtful that the other hospice providers in the area would have been able to accommodate all of the hospice’s patients. As a result, patients may have been forced to leave their families and community and be placed elsewhere in the state or go without the hospice care that they had chosen and that their attending physicians had certified that they needed. The hospice had patients who were receiving care in its inpatient hospice facility (the only one in the area) and who would have needed to be transferred to another non-hospice inpatient facility, most likely a nursing home. Because of the backlog and delay in obtaining an ALJ Hearing, all of this catastrophic and irreparable harm would have occurred before the hospice received its first opportunity for full and fair review by an independent party, and even though such review results in reversals of the claim denials approximately 70% of the time.

Armed with the facts above, the hospice filed a Complaint and a Motion for Temporary Restraining Order in federal court seeking to prevent recoupment pending completion of the administrative review procedures, including the ALJ Hearing. The hospice argued, among other things, that the review process the hospice had received up to that point was so systemically flawed that it was constitutionally insufficient. The Court granted a Temporary Restraining Order, which temporarily prevented any recoupment and set the matter for a hearing on the hospice’s motion for a preliminary injunction.

At the hearing on the preliminary injunction, the hospice was able to show that it had not received sufficient procedural due process to protect it from an erroneous deprivation of its property. The hospice was able to demonstrate through government reports that the only pre-recoupment administrative review that it had received up to that point was so systemically flawed that approximately 70% of the overpayment determinations that remain after these reviews are reversed at the next level of review. In addition, it showed that the overpayment determinations, as well as the statistical methodology used, were likely to be reversed in an ALJ hearing. The hospice showed that, due to the backlog of ALJ appeals, it would not receive an ALJ decision within 90 days of request as required by statute, but would instead be forced to wait at least three to five years for a decision. Finally, it demonstrated the catastrophic harm that would result to the hospice if recoupment were allowed to proceed as well as the harm to the hospice’s patients and the community at large if the hospice were forced to close.

 At the close of the hearing, the Court implored all parties to consider a resolution that would permit the hospice to remain open and continue to operate while it pursued its administrative appeals. Ultimately, CMS agreed to a significantly reduced payment schedule that was more reflective of the likelihood that the underlying overpayment determinations would be reversed and, most importantly, that was sufficiently manageable for the hospice to allow it to continue to deliver high-quality services to its hospice patients while it awaits its ALJ hearing.

Jason Bring and Jerad Rissler of Arnall Golden Gregory LLP represented the hospice provider in the federal court action seeking injunctive relief and represent the hospice in the pending administrative appeals.

 

Back

 










©  National Association for Home Care & Hospice. All Rights Reserved.