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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. 

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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.

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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

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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

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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.

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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.

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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.

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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.

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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.

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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.

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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. 

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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.

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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.

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Frank E. Moss, former U.S. Senator

Anyone working on health care issues in Congress knows the name Val J. Halamandaris.

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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.

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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.

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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.

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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.

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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.

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Former President Bill Clinton

Senate Finance Committee Chairman and Ranking Member Introduce Bill to Reduce Medicare Appeals Backlog

December 17, 2015 09:55 AM

On Wednesday, December 9, United States Senate Finance Committee Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR) introduced the Audit & Appeals Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015 (S. 2368), legislation designed to improve the Medicare audit and appeals process, and reduce the backlog of hearings and appeals.

The backlog of appeals is having an adverse effect on beneficiaries and providers. Under Medicare law a decision must be issued by a Medicare Administrative Law Judge (ALJ) within 90 days following the filing of an appeal by the Medicare beneficiary or provider. However, the appeal system is backlogged with nearly 900,000 appeals pending review before a handful of ALJs. With stepped up claims reviews in all provider sectors in Medicare, the number of appeals has increased exponentially. Despite efforts by the Office of Medicare Hearings and Appeals (OMHA) to expand the number of ALJs and achieve greater efficiencies in processing appeals, with 14,000 new appeals filed every week, a decision on any current ALJ appeal is over a year away.

“At a time where it takes up to a year and a half to process Medicare appeals, this bill addresses the massive backlog of Medicare appeals and offers more protection to beneficiaries and more certainty for healthcare providers,” Chairman Hatch said. “This a common-sense fix that will improve our healthcare system for both patients and providers, and I look forward to working with my colleagues on both sides of the aisle in getting this bill passed in the Senate.”

“I’m proud the Finance Committee has come together to make smart, common-sense changes to the audit and appeals system in Medicare so there is less red tape and the tremendous backlog of claims can be processed,” Ranking Member Wyden said.“The challenges facing the audits and appeals process today hurt providers, beneficiaries, and states, and it’s time to take action on these bipartisan reforms. I hope the Senate can swiftly take up and pass this bill.”

Following are provisions in the bill as described in the report language that were designed to improve the appeals process and reduce the backlog:

  • Increased resources for the Medicare appeals process.
  • Establishment of Medicare magistrate reviews - The bill would establish within OMHA decision-making officials known as Medicare magistrates to review and render decisions on certain appeals.
  • Creation of a settlement process for appellants - Beginning in calendar year 2017, the bill would require the Secretary to establish alternative dispute resolution processes, including mediation, in which providers, suppliers, beneficiaries, or State Medicaid Agencies could voluntarily resolve large volumes of pending appeals involving similar issues of law or fact. 
  • Authority to use sampling and extrapolation methodologies and to consolidate appeals for administrative efficiency - Provides review entities with the authority to use sampling and extrapolation methodologies, and to consolidate appeals for administrative efficiency.
  • Remanding appeals to the redetermination level with the introduction of new evidence - Requires a Qualified Independent Contractor, a Medicare magistrate, an ALJ, or the Departmental Appeals Board to remand an appeal to the Medicare Administrative Contractors (MACs) for a redetermination when the appellant introduces new evidence into the administrative record at a subsequent level of appeal.
  • Expedited access to appeals - The bill requires the Secretary of Health and Human Services to establish and implement a process whereby ALJs and Medicare magistrates could issue decisions, based on the evidence of record, without holding a hearing when there are no material issues of fact in dispute and the ALJ or the Medicare magistrate determines that there is a binding authority that controls the decision in the matter under review. 

In addition to strengthening the appeals process, the legislation also includes reforms to address the high number of audits, including reforms to how MACs are incentivized, and creating a Medicare Supplier and Provider Ombudsman for Reviews and Appeals.

Prior to introduction of the bill, the National Association for Home Care & Hospice (NAHC) met with the Senate Finance Committee and provided several recommendations that were included in the legislation to improve the Medicare appeals process and to reduce the backlog. Included in the legislation were NAHC’s recommendations to increase resources for the Medicare appeals process, improve the accuracy and quality of determinations, and establish a settlement process for appellants.The language is largely permissive, providing the potential for positive reforms rather than any direct assurance that the backlog will be significantly reduced. While NAHC continues to review the full legislation, the inclusion of its recommendations is a positive step.

It is estimated that over 30,000 appeals involving hospice or home health services are pending in the backlog. It is believed that the majority involve claim denials based on the now-eliminated narrative requirement in the home health face-to-face physician encounter rules. The settlement authority in the Senate legislation provides the means by which these claims can be resolved without waiting the years that it will take to clear out the appeals backlog. However, if the legislation is enacted, it leaves it to CMS’ discretion whether it would consider a settlement approach to these appeals. As such, NAHC continues to pursue alternative legislative and judicial solutions that more directly address the home health and hospice backlogs. 

Stay tuned to NAHC Report regarding the status and additional information about this legislation. 

 

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