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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

MedPAC to Recommend Zero Hospice Update for FY 2017

Future discussions to include hospice in NF, variation in utilization by provider type
December 11, 2015 12:00 PM

At its meeting held on December 10, 2015, the Medicare Payment Advisory Commission (MedPAC) discussed recent changes to the Medicare hospice benefit as well as reviewed data on payment adequacy and benefit utilization as part of its discussion on payment recommendations to be included in its annual March Report to Congress. After consideration of these factors, the panel gave preliminary approval to a recommendation that Congress eliminate the hospice payment update for fiscal year (FY) 2017. The Commission will meet in January to finalize its recommendations.  MedPAC plans to monitor the redistributional impact of the payment reform changes scheduled to go into effect on January 1, 2016, as part of future payment adequacy discussions.

As part of its deliberations on payment adequacy, the panel reviewed factors related to access (including the supply of providers and volume of services provided), quality of care, access to capital, and hospice payments/costs. This is the standard framework MedPAC uses when developing payment recommendations for all provider types. MedPAC staff indicated that between 2013 and 2014:

  • The supply of hospices increased by 4 percent (driven by an increase in for-profit providers);
  • The percent of Medicare decedents using hospice increased by 0.5 percentage points;
  • The number of hospice users increased by 9,000;
  • Length of stay remains stable;
  • The hospice live discharge rate dropped by 0.8 percentage points; and
  • Access to capital appears to be adequate.

MedPAC staff projects that the financial margin for hospice providers in 2016 will be approximately 7.7 percent, as compared with an estimated margin of 8.6 percent in 2013. The projected 2016 margin takes the following factors into consideration: market basket, productivity, and other legislated payment adjustment; full elimination of the budget neutrality adjustment factor; and the sequester. Staff noted that the financial margin calculation rate excludes the cost of bereavement and certain volunteer services, which would further reduce the financial margin by 1.7 percent at most.

MedPAC also calculated a “marginal profit rate” for hospice providers of 12 percent; the “marginal profit rate” was defined as the degree to which Medicare payments exceed the cost of caring for an additional patient. This was the first year that MedPAC discussions on hospice payment adequacy included calculation of a marginal profit rate.

In expanded discussions, the panel expressed an interest in future discussion of hospice care for patients in nursing facilities, including length of stay, higher profits, and resulting efficiencies for both hospice and nursing home providers. Additionally, in light of differences in length of stay, margins, and other factors among different types of hospice providers, the panel expressed an interest in further discussion of hospice provider characteristics and business models.

It is anticipated that a transcript of the meeting and a copy of the presentation slides will be posted to the MedPAC webpage during the week following the December 10 - 11 meeting.




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