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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

Senate Finance Committee Releases Chronic Care Options Paper, Seeks Input

December 29, 2015 08:17 AM

On December 18, the US Senate Committee on Finance released a white paper on chronic care titled, “Bipartisan Chronic Care Working Group Policy Options Document.”  Last year, the Committee took its first step in an important initiative to improve care for the millions of Americans managing chronic illness by holding a hearing in July 2014.  The hearing was titled “Chronic Illness:  Addressing Patients’ Unmet Needs”.    The Committee continued to hold hearings and seek stakeholder input through July 2015 and has released this options document summarizing key policy ideas the Committee is considering.  The National Association for Home Care & Hospice (NAHC) has been actively engaged in discussions with the Committee on this important issue; for previous coverage of some of NAHC’s activities in this area, please go here, here, and here.

Releasing this options document is intended to generate additional comments, feedback, and input from Finance Committee members and stakeholder groups as the Committee works on a more finite list of policy ideas that the working group believes may have the greatest potential to improve care coordination in the Medicare program.

As a result of the feedback received thus far, the working group outlined three main bipartisan goals that each policy under consideration should strive to meet:

  • The proposed policy increases care coordination among individual providers across care settings who are treating individuals living with chronic diseases;
  • The proposed policy streamlines Medicare’s current payment systems to incentivize the appropriate level of care for beneficiaries living with chronic diseases; and
  • The proposed policy facilitates the delivery of high quality care, improves care transitions, produces stronger patient outcomes, increases program efficiency, and contributes to an overall effort that will reduce the growth in Medicare spending.

The Committee states that a key factor in this process will be the involvement of the Congressional Budget Office (CBO) in scoring proposals and their impact on federal spending.

The policies under consideration affect hospice, home health, palliative care and other providers.  The policies are grouped according to the following categories:

  • Receiving High Quality of Care in the Home
  • Advancing Team-Based Care
  • Expanding Innovation and Technology
  • Identifying the Chronically Ill Population and Ways to Improve Quality
  • Empowering Individuals and Caregivers in Care Delivery
  • Other Policies to Improve Care for the Chronically Ill

The Advancing Team-Based Care section of the Options Document may be of particular interest to hospice and palliative care providers.  One of the policies under consideration in this category is requiring Medicare Advantage (MA) plans to offer the hospice benefit provided under traditional Medicare. This is not a new consideration as the Medicare Payment Advisory Commission (MedPAC) has previously made and is still considering this as a recommendation to Congress.  Per this options document the Committee would require the full scope of the hospice benefit, including the required care team and written care plan, remain. If a policy change is made, the current MA payment system would need to be adjusted to take into account this additional benefit. In addition, the MA five-star quality measurement system would need to be updated to include measures associated with hospice care. Such additional quality measures would include, but are not limited to, health outcomes (including patient satisfaction) and appropriate level of care.

The working group is soliciting feedback on

  • Specific plan-level measures that could be used to ensure that MA hospice beneficiaries are receiving appropriate and high-quality care.
  • Other safeguards that should be in place to ensure MA enrollees have access to high quality hospice services.

Under current law, MA enrollees may elect to use hospice, but are either required to disenroll completely from MA or receive a combination of services from traditional Medicare and MA. Both of these options lead to either a disruption in care or fragmented care delivery.

Overall, the working group is looking at what is included as part of the MA plan and is considering policy changes that would allow other types of patients who do not currently consistently receive MA plan benefits to do so, i.e. ESRD patients.

The chronic care working group is considering giving MA plans the flexibility to establish a benefit structure that varies based on chronic conditions of individual enrollees. This flexibility would allow a MA plan to provide tailored benefits that would reasonably be expected to improve the care and/or prevent the progression of the chronic conditions affecting MA enrollees.

Specifically, the chronic care working group is considering allowing MA plans to offer:

  • Additional supplemental benefits not currently allowed that are related to the treatment of the chronic condition or the prevention of the progression of the chronic disease;
  • Reduction in cost sharing for items/services that treat the chronic condition or prevent the progression of the chronic disease;
  • Adjustments to provider networks that allow for a greater inclusion of providers and non- clinical professionals to treat the chronic condition or prevent the progression of the chronic disease; and
  • Care improvement and/or wellness programs specifically tailored for the chronic condition.

Currently, MA plans must offer the same benefit package to all of its enrollees, despite the different health needs of these enrollees. Allowing MA plans to specifically tailor their benefit package to meet the needs of chronically ill individuals will help improve management of chronic diseases and/or prevent the progression of these diseases.

The working group is also considering establishing a new high-severity chronic care management code that clinicians could bill under the Physician Fee Schedule. A new code would reimburse clinicians for coordinating care outside of a face-to-face encounter for Medicare’s most complex beneficiaries living with multiple chronic conditions. The current chronic care management code covers a portion of the labor-intensive cost, the proposed new high-severity code payment would be higher to compensate providers who require more than the typical allotted time per month.  Currently, hospice physician cannot bill the chronic care management codes.

Another consideration related to physician payment and care of the chronically is  the establishment of a one-time visit code post initial diagnosis of Alzheimer’s/dementia or other serious or life-threatening illness.  This one-time payment would recognize the additional time needed to have conversations with beneficiaries who have received a diagnosis of a serious or life-threatening illness, such as Alzheimer’s/dementia. The purpose of this visit would be to discuss the progression of the disease, treatment options, and availability of other resources that could reduce the patient’s health risks and promote self-management. Other diagnoses that might fall under this category were not mentioned.

A specific subset of the chronically ill mentioned in the document is behavioral health.  This is interesting as those with a behavioral health diagnosis are more readily recognized as having significant needs that, when addressed, improve overall quality of care and decrease costs.

Other considerations in the document include:

  • Modifying the requirements for reimbursement for telehealth services provided by ACOs in the Medicare Shared Savings Program (MSSP)
  • Digital coaching - requiring the Centers for Medicare & Medicaid Services (CMS) to provide medically-related information and educational tools on its website to help beneficiaries learn more about their health conditions and help them in the self-management of their own health.
  • Changing the risk adjustment payment model for MA plans
  • Increasing transparency at the Centers for Medicare and Medicaid Innovation (CMMI)
  • Developing quality measures that focus on the health care outcomes for individuals with chronic disease. Topic areas related to chronic conditions that the working group is specifically considering include:
    • Patient and family engagement, including person-centered communication, care planning, and patient-reported measures;
    • Shared decision-making;
    • Care coordination, including care transitions and shared accountability within a care team;
    • Hospice and end-of-life care, including the process of eliciting and documenting individuals’ goals, preferences, and values, quality of life, receipt of appropriate level of care, and family/caregiver experience of care;
    • Alzheimer’s and dementia, including measures for family caregivers, outcomes, affordability, and engagement with the healthcare system or other community support systems;
    • Community-level measures, in areas such as obesity, diabetes and smoking prevalence. 

    • The working group is also considering recommending that Government Accountability Office (GAO) conduct a report on community-level measures as they relate to chronic care management. The report would discuss appropriate measures in this domain and provide recommendations for holding providers accountable to community-level measures, linking provider payment to these measures, and encouraging the use of these measures.

The working group realizes there are other specific topics beyond those outlined that affect individuals with chronic diseases. In particular, there are certain gaps that should be studied in further depth due to their potential high impact on chronic disease management.

The working group is requesting that any individuals, researchers, businesses, organizations, or advocacy groups that are interested in submitting comments – specific to the content and questions outlined in this document – should send a letter or an email to the Senate Finance Committee by January 26, 2016.  Instructions for submission are found at the beginning of the document.  NAHC will be compiling comments.  Please send feedback to Theresa Forster at or Katie Wehri at 




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