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National Association for Home Care & Hospice
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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

OIG Finds Inappropriately Billed Hospice GIP, Urges Further Action by CMS

April 4, 2016 08:18 AM

The Department of Health & Human Services  (HHS) Office of the Inspector General (OIG) has issued its most recent report examining hospice use of general inpatient care (GIP) (Hospices Inappropriately Billed Medicare Over $250 Million for General Inpatient Care -- OEI-02-10-00491), as well as a podcast on the topic.  The OIG drew a random sample of 565 GIP stays during 2012 for review and found that 31.4 percent of the GIP stays were billed inappropriately, the value of which was $268 million.  In almost all of the cases, the OIG believed that patient records contained insufficient documentation of need for either the entire GIP stay or a portion of the stay.  In a small percentage of cases the OIG believed there was no evidence that the patient had elected hospice or that the patient was eligible for hospice care.  The OIG indicated that it plans to issue a companion report in the future examining the election statements and certifications of illness for beneficiaries who received GIP.

Under hospice, GIP is the second most costly level of care and is the second most commonly used level of care.  According to the Medicare Benefit Policy Manual, “A general inpatient care day is a day on which an individual who has elected hospice care receives general inpatient care in an inpatient facility for pain control or acute or chronic symptom management which cannot be managed in other settings [emphasis added].”  GIP may only be provided in an inpatient hospital, skilled nursing facility or an inpatient hospice facility.   Following is a list of the major findings cited by the report:

  • Hospices billed one-third of GIP stays inappropriately, costing Medicare $268 million in 2012
  • Hospices commonly billed for GIP when the beneficiary did not have uncontrolled pain or unmanaged symptoms
  • Some states had many inappropriate GIP stays (with Florida, Ohio and Arizona being identified as states with high inappropriate GIP levels)
  • Hospices billed inappropriately for about half of GIP stays in SNFs
    • Hospices were more likely to inappropriately bill for GIP provided in SNFs than in other settings
    • Diagnoses of patients receiving GIP in SNF differed from those of beneficiaries receiving GIP in other settings -- they were more likely to involve a beneficiary diagnosed with a “mental disorder, ill-defined condition, or Alzheimer’s disease”
  • For-profit hospices were more likely than other hospices to bill inappropriately for GIP
  • Medicare sometimes paid twice for drugs for beneficiaries receiving GIP (under the hospice bundled payment and then with payment through Part D)
    • The OIG determined that Part D paid inappropriately for over half (110 of 198) of the drugs billed to Part D for patients receiving the GIP stays
    • The 110 drugs were used primarily for relief of pain and symptom control related to the terminal illness
  • Hospices did not meet care planning requirements for 85 percent of GIP stays
    • For 72 percent of GIP stays, the hospice care plan was missing at least one key element (this could be the frequency or scope of at least one main service type or the care plan did not appear to be individualized for the specific patient)
    • In about half the stays, the plan of care development did not involve all of the required disciplines
  • Hospices sometimes provided poor quality care and often did not provide intense services -- including insufficient provision of nursing, physician, or medical social services visits
    • Hospices did not provide any medication subcutaneously to beneficiaries in more than three-quarters of GIP stays

The OIG recommendations and CMS responses are provided below:

  • OIG recommended that CMS increase its oversight of hospice GIP claims and review Part D payments for drugs for hospice beneficiaries; CMS requested additional information on the hospices studied by the OIG so that it could conduct follow up investigation and also described policies relative to hospice/Part D that were implemented in 2014.  CMS plans to conduct further analysis to evaluate the impact of the revised Part D policy
  • OIG recommended that CMS should ensure that a physician is involved in the decision to use GIP; CMS agreed but expressed concern about requiring a physician order for GIP as it could delay services.  CMS also expressed concern about requiring inclusion of the NPI of the physician ordering GIP on the claim could require costly systems changes.
  • OIG recommended that CMS conduct prepayment reviews for lengthy GIP stays; CMS indicated that it plans to talk to the Medicare Administrative Contractors (MACs) about such action
  • OIG recommended that CMS Increase surveyor efforts to ensure that hospices meet care planning requirements; CMS concurred and indicated it will revise training materials for hospice surveyors to put proper emphasis on this area.
  • OIG recommended that CMS establish additional enforcement remedies for poor hospice performance; CMS concurred and indicated that it will consider this in future budget requests to the Congress.  CMS will also address poor hospice performance through its protocols.
  • OIG recommended that CMS follow up on inappropriate GIP stays, inappropriate Part D payments, and hospices that provided poor-quality care; CMS concurred and indicated it would follow up on data received from the OIG and analyze the merits of conducting additional reviews of the claims.  CMS will also develop further educational materials for providers.

The National Association for Home Care & Hospice (NAHC) notes that since 2012 (the year from which claims were drawn for this study) there have been numerous changes in the hospice arena, including the release by CMS of data identifying concerns about particular patterns of care in hospice, enactment of a legislative requirement that hospices be surveyed no less frequently than every 36 months, increased medical review by the MACs, and other activities.  MACs have also provided additional education specific to criteria for the GIP level of care.  NAHC believes that hospice providers are undergoing increased self-scrutiny as the result of these developments.  NAHC would also note that it believes the vast majority of hospices comply with the requirement that a physician order be present when the hospice plan of care directs a change in the level of care, as a change in level of care signals a change in the patient’s condition which requires the hospice interdisciplinary group (IDG), including the patient’s attending physician (if any), to revise and document the individualized plan of care (see 418.56(d))  Regardless, NAHC encourages hospices to study the OIG report and conduct a thorough review of its policies and processes regarding utilization of GIP to ensure full compliance with existing rules and regulations. NAHC is also planning further education on this topic.




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