Skip to Main Content
National Association for Home Care & Hospice
Twitter Facebook Pintrest


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

NAHC Comments on Senate Finance Committee’s Chronic Care Policy Options: Home Care Comments (Part 1 of 2)

January 29, 2016 09:45 AM

This article summarizes NAHC’s comments on the Senate Finance Committee’s Chronic Care policy options pertaining to home care. The policies under consideration by the Committee affect hospice, home health, palliative care and other providers.A subsequent article will summarize NAHC’s comments on the policies pertaining to hospice.

The National Association for Home Care & Hospice (NAHC) has submitted comments to the U.S. Senate Finance Committee regarding the Chronic Care Working Group’s policy options document titled, the “Bipartisan Chronic Care Working Group Policy Options Document.” As reported in the December 29, 2015, edition of NAHC Report (available here), the Senate Finance Committee released the policy options document in December 2015 after announcing the creation of the Working Group in June 2015. 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 herehere, and here. Releasing the options document was 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 to improve care coordination in the Medicare program.

“We strongly support the direction of the Working Group in considering that caring for individuals with chronic illness in their own homes should be a central aim of any policy reforms,” NAHC stated in its comments submitted to the Senate Finance Committee. “Home care presents the best opportunities to provide high quality care while controlling Medicare spending. It is also a quickly scalable way of coping with the fast-growing population of Medicare beneficiaries as the baby-boomer generation ages.”

With regards to home care, NAHC submitted the following recommendations and comments based on the categories included in the options document:

Expanding the Independence at Home Model

NAHC expressed support for the option of expanding the Independence at Home (IAH) demonstration, and provided specific recommendations for expanding IAH in order to build on its success. Currently, IAH is limited in size and scope. There are only 17 entities in the program, and it is also limited in the Medicare population it serves (only the 5 percent highest risk patients). NAHC stated, “[IAH] has the potential, with design modifications, to serve a greater patient base in an equally effective way. Building on the successes of IAH in expanding both the sites and scope of the model should be a win-win for patients and Medicare.”

NAHC recommended modifying the interdisciplinary team in order to expand the scope of IAH. “While the high risk patients likely need a physician team leader, patients in the lower stratums of risk may not. Accordingly, the team composition and leadership should be flexible, required to be composed in a manner that fits the individual patient.”

The expansion of IAH, NAHC said, should be comprehensive in scope with a schedule that addresses both the number of sites and target populations. With respect to modifying the delivery model, NAHC reiterated its support for a Home-based Chronic Care Management Model, a partnership between home health agencies and patient-centered medical homes that more fully treats the “whole” patient. This model is currently referred to as the “Integrated Care Model” (ICM). “This model would benefit both homebound post-acute patients and pre-acute chronically ill patients,” NAHC said, “while keeping chronically ill patients out of inpatient settings.” The Model would build on IAH in a number of ways, NAHC said, while including a broader focus than IAH, which is limited to the 5 percent of patients most at risk of hospitalization.

Another benefit to the Model is that “advanced technological tools are incorporated into the care management to achieve greater efficiencies, accelerated care actions, and targeted remedial measures.” Furthermore, the model “presents a payment method that fits with the direction of value-based payment and shared risk between provider and payer.” NAHC included a detailed outline of ICM, and cited several successful examples of home care agencies implementing ICM with successful results.

Establishing a One-Time Visit Code Post Initial Diagnosis of Alzheimer’s/Dementia or Other Serious or Life-Threatening Illness

The Committee asked for feedback regarding establishing a one-time visit code post initial diagnosis of Alzheimer’s/Dementia or other serious or life-threatening illnesses, in terms of the scope of diseases that would be considered a serious or life-threatening illness. NAHC stated that “the types of diseases that would fall into the broad category of serious or life threatening are those that are not curable but require medical supervision of at least two visits per year and an ongoing regimen of treatment.” NAHC further stated that “it is best to develop guidelines applicable to all serious and life-threatening illnesses” given the broad scope, rather than developing “criteria for each illness.”

Improving Care Management Services

NAHC recommended the removal of any and all barriers to the use of non-physician practitioners (NPPs) in the care of chronically ill Medicare beneficiaries. “It is the primary care practitioner who is usually managing the care of people afflicted with multiple chronic illnesses,” NAHC said. “Yet, antiquated Medicare policies, borne out of the 1960s, still limit Medicare coverage when the patient’s primary care practitioner is an NPP.” NAHC referenced legislation currently pending in the Senate, S. 578, the Home Health Care Planning Improvement Act of 2015, sponsored by Senators Susan Collins and Chuck Schumer along with a combined total of 42 bipartisan cosponsors.

Telehealth Risk-Sharing Proposal: Reducing Inpatient Care through Technology

NAHC expressed support for the Policy Option to expand the use of telehealth services to better manage the care of patients, reduce hospitalizations, and create cost savings. NAHC recommended two changes to existing Medicare standards. “First, given the Working Group’s commitment to caring for those with chronic illness in their own homes, the ‘originating site’ standard should be revised to include the home. Second, remote monitoring services coverage under Medicare should be extended to care provided by any health care professional.” NAHC also recommended the Committee “consider legislation providing authority to CMS to test the value of care models that rely on the use of telehealth in home care settings.”

Maintaining Flexibility to Provide Supplemental Services in ACOs and any Innovative Model

NAHC recommended that the Working Group support the waiver of the Medicare home health services “confined to home” or homebound requirement in innovative care models such as ACOs, post-acute care bundling, Independence at Home, and the recently initiated Complete Joint Replacement bundle model. “The failure [by CMS] to extend that waiver in these innovative programs limits the intended flexibility that is at the heart of these new models. That flexibility is the chief means by which the innovations can bring about improvements in patient outcomes and spending,” NAHC said.

Encouraging Beneficiary Use of Chronic Care Management Services

NAHC stated that the existing Medicare home health benefit provides an opportunity to broaden the scope and delivery of care management services to chronically ill Medicare beneficiaries. “Part of the problem is the inaccurate assumption that the Medicare home health benefit is a limited, post-acute short term benefit for individuals with an acute condition,” NAHC said. “However, it is one of the best designed benefits in Medicare, permitting coverage of patients with chronic illnesses in a coordinated and comprehensive manner.” NAHC recommended that the Committee “require CMS to engage in nationwide education of its contractors and home health agency personnel focused on this one basis for coverage. If needed, clarifying or expanded policy guidelines should be issued. In the end, an application of this covered service in home care can create the foundation for significant improvement in patient-centered, community-based chronic care management that benefits Medicare beneficiaries and the Medicare program bottom-line.”

Developing Quality Measures for Chronic Conditions

NAHC encouraged the Working Group to use the data collected through Outcome Assessment Information Set (OASIS) assessment tool “as the primary starting point for the new measure development needed to advance any payment reforms.” However, NAHC stated, “we caution that OASIS data is skewed toward patient improvement outcomes that do not universally fit for patients with chronic illness as the goals for those patients may be maintenance or slowed deterioration in their clinical conditions. The Star Rating system totally excludes these types of measures.”

With regards to Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey, NAHC said its “members have reported that there are some limitations associated with the HHCAHPS survey, as a patient’s satisfaction with the care they receive may not reflect the quality of care provided in some instances. Additionally, responses provided by a patient’s friend or family member may not provide a true picture of the care received by the patient as many patients may not share complete details regarding their health condition(s) with others. As such, we believe that HHCAHPS results should be a small component of any system that links payment to quality, if at all.”

Furthermore, NAHC stated that the patient population is “very heterogeneous,” and as such “the use of the same benchmarks or targets may not be appropriate.”

NAHC’s comments are available here.




©  National Association for Home Care & Hospice. All Rights Reserved.