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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 Continues Discussion on Unified Prospective Payment System for Post-Acute Care

January 22, 2016 11:58 AM

On Friday, January 15, 2016, the Medicare Payment Advisory Council (MedPAC) held a meeting to continue its discussions on developing a unified prospective payment system (PPS) spanning the post-acute care (PAC) settings. As mandated under the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, MedPAC is required to develop a prototype PPS, using the uniform assessment data gathered previously during the Centers for Medicare & Medicaid Services (CMS) Post-Acute Care Payment Reform Demonstration (PAC-PRD) completed in 2011.

Current policy involves four separate, setting-specific payment systems with different payments for similar patients. MedPAC has been critical of the home health and SNF payment systems based on the perception that they encourage providers to furnish therapy that is unrelated to a patient’s care needs. The objective of the unified payment system would be to span the four settings and correct perceived short-comings, basing payments on patient characteristics and not site of care. The first of the two mandated reports is due at the end of June 2016, and it must recommend features of a unified payment system and, to the extent feasible, estimate the impacts of moving to such a system. A second report, due around June 2023, must propose a prototype design.

This was the third session MedPAC has held considering the design, testing and impacts of a PAC PPS. At the September meeting, MedPAC discussed the overall approach to the mandate and the results of modeling stays in CMS’s PAC demonstration, and determined that a unified PAC PPS looked feasible. At the November session, MedPAC discussed possible complementary policies that could be implemented to counter volume incentives that would remain in the payment system, including a readmission policy, value-based purchasing program, and the use of a third-party PAC benefit manager. MedPAC also discussed waiving setting-specific regulations and moving toward a common set of conditions of participation.

During the January 2016 meeting, MedPAC discussed the results of a modeling analysis of PAC stays in 2013 under a unified payment system; considered the need for certain payment adjusters; and estimated the impacts on payments. The mandated report due in June 2016 has two requirements: 1) Evaluate and recommend features of a PAC PPS using data from the PAC-PRD; 2) Consider the impact of implementing a unified PAC PPS. In order to comply with the mandates, MedPAC developed three models, each with a specific purpose. The first model uses unique data in the PAC-PRD to test the feasibility of a PAC PPS. The second “administrative” model predicts relative costs of PAC-PRD stays, without relying on unique PAC-PRD data, and compares the accuracy of models using same stays, in order to assess the accuracy of an administrative model that could be used on a large sample of stays. The third “administrative” model estimates impacts with all PAC stays. MedPAC relied of a variety of patient groups to evaluate the results, including clinical groups, a variety of impairment and severity groups, community groups, and others such as the aged and disabled.

In testing the models, MedPAC found the full and administrative models predicted “very similar” relative costs of stays for most groups and explained similar shares of the variation in costs across stays. MedPAC also found that the administrative data can be used to establish accurate relative weights for most groups and estimate the impacts of a PAC PPS. However, MedPAC found certain groups had average predicted costs that deviated from average actual costs, and which “may warrant payment adjustment,” including unusually short stays (to prevent large overpayments), and high-cost outliers (to protect providers from large losses). MedPAC also found differences that “may warrant further study” including low-volume, isolated providers (to ensure access) and extremely sick patients (to ensure access).

With regards to estimating the impact of a PAC PPS, MedPAC assumed the same level of aggregate payments as under current law; did not reflect policy changes since 2013; and did not assume any changes to provider behavior. MedPAC found that a PAC PPS would narrow the difference between payments and actual costs across most patient groups. A PAC PPS is estimated to shift payments across stays, with payments increasing for some groups and decreasing for others. For example, payments would increase for many of the medically complex and patient impairment and severity groups. Meanwhile, payments would decrease for clinical groups where rehabilitation therapy is a key component of care with therapy services unrelated to patient characteristics; and also decrease for many types of stays treated in higher-cost settings that are also treated in lower-cost settings.

Among the implications from the analysis was that payments for stays in home health will need to be aligned with the setting’s lower cost. In addition, MedPAC stated that a payment adjuster for short-stays will likely be needed, and that low-volume, isolated providers may need protections.

MedPAC members generally agreed that a PAC PPS is feasible and would break down silos between settings. In March 2016, MedPAC will meet again to further discuss the need for an adjuster for low-volume, isolated providers and look at a prototype outlier policy. MedPAC will also discuss different ways to establish the aggregate level of payments. In April 2016, MedPAC will finalize the report, which is due at the end of June 2016.

The National Association for Home Care & Hospice(NAHC) is open-minded with regards to the development of a unified PAC PPS. NAHC awaits further detail on the prototype, as the lack of detail that MedPAC has provided so far prevents a full assessment of its potential. NAHC’s position is that any such effort must:

  • Take into account that the majority of home health services do not meet the definition of post-acute care, based on the fact that many patients enter home health from the community rather than from an institutional setting;
  • Consider that, whereas all of the other relevant settings are under the control of the provider, the home is under the control of the patient, which creates different issues with regards to risk adjustment;
  • Recognize that home care for many patients is a clinically necessary setting, not just an acceptable one, based on the patients’ condition and the fact that they are protected by being at home;
  • Be developed with full transparency and fully tested for reliability.

Stay tuned to NAHC Report for further analysis of MedPAC’s efforts on a unified PAC PPS.




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