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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

Medicaid Provisions Affecting Home Care in the President’s FY2017 Budget

February 22, 2016 10:45 AM

As previously reported in the February 9, 2016, edition of NAHC Report (available here), U.S. President Barack Obama has released his $4.1 trillion fiscal year (FY) 2017 budget proposal, which contains proposals of significant concern to the home care and hospice community. However, the President’s budget also includes several Medicaid proposals regarding delivery reform to incentivize home and community-based services; access to and coverage of services; quality and cost-effectiveness; and the integrity of the Medicaid program. Following are summaries of these Medicaid proposals as included in the President’s FY2017 budget:

Delivery System Reform

Allow Full Medicaid Benefits for Individuals in a Home and CommunityBased Services State Plan Option.This proposal provides states with the option to offer full Medicaid eligibility to medically needy individuals who access home and community‐based services through the state plan option under section 1915(i) of the Social Security Act.  Currently, when a state elects to not apply the community income and resource rules for the medically needy, these individuals can only receive 1915(i) services and no other Medicaid services.  This option will provide states with more opportunities to support the comprehensive health care needs of individuals with disabilities and the elderly. [$9 million in costs over 10 years]

Expand Eligibility for the 1915(i) Home and CommunityBased Services State Plan Option.This proposal increases states’ flexibility in expanding access to home and community‐based services under section 1915(i) of the Social Security Act.  Currently, certain non‐categorically eligible individuals who meet the needs‐based criteria can only qualify for home and community‐based services through the 1915(i) state plan option if they are also eligible for home and community‐based services through a waiver program.   This proposal removes this requirement, which will reduce the administrative burden on states and increase access to home and community‐based services for the elderly and individuals with disabilities. [$374 million in costs over 10 years]

Expand Eligibility Under the Community First Choice Option.This proposal provides states with the option to make medical assistance available to individuals who would be eligible under the state plan if they were in a nursing facility.  Under the current statutory language, any state interested in the Community First Choice Option must create or maintain a section 1915(c) waiver with at least one waiver service to make the Community First Choice benefit available to the special income group.  The 1915(c) waivers are an option available to states to allow long‐term care services in home and community‐based settings under Medicaid.   This process is administratively burdensome for states.   This proposal provides equal access to services under the state plan option and provides states with additional tools to manage their long‐term care home and community‐based service delivery systems.   [$3.9 billion in costs over 10 years]

Pilot Comprehensive LongTerm Care State Plan Option.This eight‐year pilot program would create a comprehensive long‐term care state plan option for up to five states.  Participating states would be authorized to provide home and community‐based care at the nursing facility level of care, creating equal access to home and community‐based care and nursing facility care.  The Secretary would have the discretion to make these pilots permanent at the end of the eight years.   This proposal works to end the institutional bias in long‐term care and simplify state administration. [$4.1 billion in costs over 10 years]

Allow States to Develop AgeSpecific Health Home Programs.The Affordable Care Act includes a provision that allows states to create Health Homes for Medicaid enrollees with chronic conditions.  Under a Health Home program, states can develop a comprehensive system of care coordination for the purpose of integrating and coordinating all primary, acute, behavioral health, and long‐term services and supports to treat the whole person.  States receive an increased federal match for Health Home services for the first eight quarters of their program.  This proposal allows states to target their Health Home programs by age.   Currently, states are required to cover Health Home services for all categorically needy individuals with the specified chronic condition(s), regardless of age.  Many states have voiced support for allowing age‐specific targeting of their Health Home model to better serve the needs of youth with chronic conditions.   [$1.1 billion in costs over 10 years]

Provide Home and CommunityBased Waiver Services to Children Eligible for Psychiatric Residential Treatment Facilities.This proposal provides states with additional tools to manage children’s mental health care service delivery systems by expanding the non‐institutional options available to these Medicaid beneficiaries.  By adding psychiatric residential treatment facilities to the list of qualified inpatient facilities, this proposal provides access to home and community‐based waiver services for children and youth in Medicaid who are currently institutionalized and/or meet the institutional level of care.  Without this change to provisions in the Social Security Act, children and youth who meet this institutional level of care do not have the choice to receive home and community‐based waiver services and can only receive care in an institutional setting where residents are eligible for Medicaid.  This proposal builds upon findings from the five‐year Community Alternatives to Psychiatric Residential Treatment Facilities Demonstration Grant Program authorized in the Deficit Reduction Act of 2005 that showed improved overall outcomes in mental health and social support for participants with average cost savings of $36,500–$40,000 per year per participant. [$1.6 billion in costs over 10 years]

Reestablish the Medicaid Primary Care Payment Increase through Calendar Year 2017 and Include Additional Providers.Effective for dates of service provided on January 1, 2013, through December 31, 2014, states were required to reimburse qualified providers at the rate that would be paid for the primary care service under Medicare.  The federal government covered 100 percent of the difference between the Medicaid and Medicare payment rate.  This increased payment rate expired at the end of calendar year 2014.  This proposal reestablishes the enhanced rate through December 31, 2017, expands eligibility to obstetricians, gynecologists, and non‐physician practitioners, including physician assistants and nurse practitioners, and excludes emergency room codes to better target primary care.   [$9.5 billion in costs over 10 years]

State Grants and Demonstrations

Money Follows the Person Demonstration.This demonstration, extended by the Affordable Care Act through FY 2016, helps states support individuals to achieve independence. States that are awarded competitive grants receive an enhanced Medicaid matching rate to help eligible individuals transition from a qualified institutional setting to a qualified home or community based setting. Approximately $3 billion has been awarded to 44 states and the District of Columbia since the program’s inception. This demonstration is funded at $450 million for each fiscal year through FY 2016. Funding awarded to states in FY 2016 is available to states for expenditures through FY 2020. These additional funds will enable state grantees to continue to develop their home‐and community‐based programs and increase the number of beneficiaries served while continuing to rebalance their long‐term care systems between institutional and community settings. As of December 31, 2014, over 51,000 individuals across 44 states and the District of Columbia have transitioned to community services and supports through this effort. In 2013, CMS awarded funding to states and tribal partners to build sustainable community‐based long‐term services and supports specifically for American Indians through the tribal initiative.

Quality and Cost-Effectiveness

Require Remittances for Medical Loss Ratios for Medicaid and CHIP Managed Care.This proposal gives CMS explicit authority to apply a medical loss ratio of 85 percent to Medicaid and CHIP managed care plans that includes a requirement that states collect a remittance of any amounts spent in excess of the medical loss ratio and returns the federal share to the federal government.  This proposal aligns Medicaid with Medicare Advantage and private insurance requirements and builds on the policies in the proposed rule on Medicaid managed care published in June 2015.  [$23.5 billion in savings over 10 years]

Medicaid Appeals

Streamline Certain Medicaid Appeals Processes. Current law restricts states’ ability to streamline and coordinate certain Medicaid appeals processes. This proposal increases flexibility for states in arranging their fair hearings functions and allows individuals to have a more coordinated and streamlined Medicaid fair hearings process by eliminating the requirement to provide a fair hearing at the Medicaid state agency for certain types of appeals when a state has opted to delegate Medicaid fair hearings to a Marketplace appeals entity or the Secretary.  [No budget impact]

Integrity of the Medicaid Program

Require States to Suspend Medicaid Payments when the Secretary Determines there is a Significant Risk of Fraud.This proposal requires state Medicaid agencies to suspend payments to providers when the Secretary determines that the providers pose a significant risk of fraud to the Medicaid program, unless the state agency demonstrates that the benefits of continuing payments to the provider outweigh the risk of losses to fraud.   [No budget impact]

Allow the Secretary to Reject Claims from New Providers and Suppliers Located Outside Moratorium Areas.This proposal permits the Secretary to reject claims for unnecessary services furnished by newly‐enrolled providers and suppliers in localities outside the moratoria areas to beneficiaries located inside that area.  Using the authorities provided in the Affordable Care Act, CMS has imposed temporary enrollment moratoria designed to stem the overabundance of certain types of providers and suppliers and the overutilization of certain types of services within particular geographic areas.  Some providers and suppliers are circumventing the moratoria by enrolling in localities just outside the moratorium area.   [$50 million in savings over 10 years]  

These and other proposals affecting home care and hospice are described in the HHS Budget at a Glance document, available here.  NAHC Report will provide further coverage of these and other proposals affecting home care and hospice patients and the providers that serve them as additional detail becomes available.




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