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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 Issues Preliminary Recommendations on Home Health Payment

December 22, 2015 06:53 AM

The Medicare Payment Advisory Commission (MedPAC) held a public meeting on December 11 to discuss tentative recommendations on Medicare home health payment policy for 2017. MedPAC is an advisory body to Congress that annually evaluates payment policy in all provider sectors in Medicare. The December meeting is a prelude to its March Report to Congress that outlines its recommendations and supporting analysis.  

The preliminary recommendations regarding home health services essentially mirror those made in recent years. These tentative recommendations include:

  • A zero percent inflation update in 2017
  • Elimination of therapy utilization as a payment level determinant in the home health prospective payment system
  • The institution of a second round of rate rebasing in 2018

While MedPAC recommendations are taken very seriously by Congress, those recommendations are not universally adopted. Nevertheless, the National Association for Home Care & Hospice (NAHC) develops its advocacy plan with full consideration of the annual MedPAC recommendations. With the 2017 version, NAHC once again finds that MedPAC’s analysis of the home health community comes up short in terms of information and depth of analysis. More importantly, MedPAC’s forecast regarding the future financial status of home health agencies is not consistent with its own trend data.

MedPAC staff presented data at the meeting focused on access, volume, quality, and Medicare margins. In 2014, MedPAC reports that there was a decline of 152 HHAs to 12,461 with that reduction mainly in states that had high growth in previous years. Volume and spending declined in terms of episodes (-2.1%), users (-1.3%), and Medicare spending (-1.6%) compared to 2013. Those declines were primarily in the same states that showed a decline in the number of HHAs.

Quality of care continues to improve, but with a minor increase in hospitalizations at the end of the episode of home health care (26.5% in 2013/27.8% in 2014).

With respect to Medicare margins, the effects of sequestration and rate rebasing are starting to show. Last year, CMS reported that the 2013 Medicare margin for freestanding HHAs (MedPAC disregards hospital-based HHAs) was 12.7%. In 2014, the first year of rate rebasing, the freestanding HHA Medicare margin dropped to 10.8%. MedPAC also presented a Marginal profit calculation indicating that the value of adding additional patients at an HHA is a profit of 13.3 percent.

As in the past, MedPAC staff has provided a narrow view of home health services by focusing on national averages. Data strongly shows that Medicare margins vary significantly from state to state. Also, the exclusion of hospital based HHAs creates a false picture in that these HHAs are the only or primary home care provider in certain geographic areas. With varying margins, reliance on a national average is a high risk when determining whether access to care is in jeopardy.

While the continuing failure of MedPAC to provide the whole picture in evaluating the financial status of HHAs is very important, MedPAC adds to the concerns in offering an estimate that Medicare margins will drop to 8.8% in 2016 as a way of supporting the recommendation on further rate rebasing. NAHC has analyzed the Medicare margin trends and concludes that, when using MedPAC’s own numbers, the 2016 margin for freestanding HHAs would be 5.23%, dropping to under 2% in 2017 because of the added case mix creep adjustments and the annual productivity adjustment. NAHC has conveyed this analysis to MedPAC with no response to date.

NAHC does support MedPAC’s recommendation that the therapy utilization factor be pulled from the HHPPS case mix model. Unfortunately, CMS has not found a way to so to its satisfaction so far.

MedPAC will reconvene in January to finalize their Congressional recommendations. In the meantime, NAHC continues to work to convince MedPAC to take a more reliable analytical approach. Fortunately, members of Congress have been willing to listen to the concerns with MedPAC’s recommendations and the same is expected in 2016.




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