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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

NAHC Details Medicare Home Health Priorities at March on Washington

April 7, 2016 11:20 AM

At the National Association for Home Care & Hospice’s (NAHC) 2016 March on Washington Conference, NAHC’s team of policy experts detailed the current legislative and regulatory priorities pertaining to Medicare home health. Subsequent NAHC Report articles will provide coverage regarding the sessions pertaining to Medicare hospice, as well as Medicaid home care, and private duty home care.

“People have asked us to get into a little bit more detail about some of the subjects that we have as our priority issues to address before Congress and before the administrative agencies,” William A. Dombi, Vice President for Law at NAHC said.  “What we want to do is delve a lot deeper into the issues related to Medicare home health.”

Oppose a “Sick Tax”—Block Efforts to Impose a Fee Paid by Patients to Access Medicare Home Health Services. Dombi said that NAHC remains committed to preventing ongoing threats to impose a home health copay, or “sick tax,” on Medicare beneficiaries. “The reality being that last year at this time, the Speaker of the House, then John Boehner, had a list of things that were going to help finance the physician SGR fix, and on that list was a Medicare home health copay,” Dombi said. “If you think the issue has gone away, even though it was only 12 months ago, it is once again on the list of recommendations from the Medicare Payment Advisory Commission and on President Obama’s final budget.”

Background: The imposition of a home health copay would a) be a “sick tax” on some of the oldest, poorest, sickest Medicare beneficiaries; b) shift seniors to more costly hospital or nursing home settings; and c) increase Medicare and Medicaid costs. A home health copay was repealed in 1972 because of the burden it placed on seniors, collection costs, and the services it shifted to more costly settings. Home health patients and their families and friends already pay a huge copayment by providing an estimated $470 billion a year in unpaid care at home, costs that would be incurred by Medicare if these patients were in a hospital or nursing home.

Repeal or Reform the Face-to-Face Physician Encounter Documentation Requirement. “The face-to-face encounter requirement is still a significant issue for home health, as you well know,” said Mary K. Carr, Vice President for Regulatory Affairs at NAHC. “Even with what CMS perceives as a fix with the elimination of the narrative, we are finding that it’s actually getting worse. With the probe end educate, we have 85-90 percent denial rates.”

“It has reached a point of helplessness at CMS for remedying this problem,” Dombi added. “CMS has had multiple opportunities to make this work. They took what we thought was a very positive step and now have turned that same positive step into a negative relative to what standards are necessary to comply with the documentation requirement.”

Background: CMS issued a rule that requires an in-person consultation between a physician and a patient no more that 90 days before the first home health services or no later than 30 days after admission to home health. CMS imposed burdensome, duplicative, costly and confusing documentation requirements that exceed the intent of the law passed by Congress. The increased paperwork burden has created a disincentive for physicians to recommend home health care. Congress should enact legislation repealing or reforming this rule.

Ban the Use of Prior Authorization in Medicare Home Health Services. “Prior authorization is something that is an extraordinary measure for CMS to use,” Dombi said. “It should only be used in a highly targeted fashion and in limited circumstances because prior authorization has been well known to be a roadblock, a barrier, to access to care for people who are duly entitled to care, and we do not want to have innocent victims of that.”

Background: CMS has proposed a prior authorization demonstration program in five states:  Florida, Illinois, Massachusetts, Michigan, and Texas.  With an estimated cost of nearly $250 million a year for CMS to administer and likely multiples of that cost for home health agencies to process nearly one million claims through that system each year, prior authorization comes at an extreme cost with no justification for its imposition on all home health agencies in the targeted states.  Overall, prior authorization is ineffective in identifying the very small number of providers that are fraudulent.   Finally, prior authorization will create significant barriers to access to home health care for beneficiaries and hospitals that are trying to transfer patients to their homes.

Allow Nurse Practitioners and Physician Assistants to Sign Home Health Plans of Care.“We just want parity with these transitions of care from the hospital to the community,” said Richard Brennan, VP for Government Affairs at NAHC.

Background: Congress should enact the bipartisan Home Health Care Planning Improvement Act (S.578; H.R.1342) that would allow Nurse Practitioners (NP) and Physician Assistants (PA) to certify and make changes to home health plans of treatment. NPs and PAs are playing an increasing role in the delivery of our nation’s health care, especially in rural and other underserved areas. Medicare reimburses NPs and PAs for providing physician services to Medicare patients. NPs and PAs can certify Medicare eligibility for skilled nursing facility services, but not more cost effective care in the home.

Following are other top Medicare home health priorities detailed at the March on Washington:

Ensure Appropriate and Adequate Reimbursement for Medicare Home Health Services

Background: Under the CMS rate rebasing rule, CMS concedes that at least forty-three percent of home health agencies will be paid less than their costs by 2017. Using more realistic numbers, the industry projects that about fifty-six percent of home health agencies will be paid less than costs by 2017. Congress should a) postpone implementation of the rule and require CMS to reevaluate the rule including consideration of all usual and customary business costs consistent with standards under the Internal Revenue Code, telehealth services, all disciplines of caregivers, and usual business operating expenses along with needs for operating capital and operating margins; b) establish transparent and accurate processes for modification of PPS payment rates and case-mix adjustmentsas set forth in the Home Health Care Access Protection Act; and c) ensure full market basket updates to Medicare home health payments.

Make Permanent the Add-On for Services to Rural Patients; Ensure Home Care Access for Rural and Underserved Patients

Background: Congress should extend the payment differential(“add-on”)forcaredeliveredin ruralareas by enacting the Preserve Access to Medicare Rural Home Health Services Act (S.2389). Congressmustalsoclosely monitor the homehealth prospective payment system to ensure thatindividual case payments are sufficient to maintain access to care. Finally, Congress should monitor adequacy of payments so thatagenciesinunderservedareas(rural,innercity,medicalshortageareas)cancontinue to provide care to Medicare beneficiaries.

Ensure Appropriate Development of Performance-Based Payment for Medicare Home Health Services

Background: Congress should monitor the progress of the ongoing value-based purchasing demonstrations or proposals and use the findings to guide its consideration of value-based payment for Medicare home health services.  Any  action in this area must: 1) be developed in conjunction with provider stakeholders; 2) be tested as a pilot program prior to full-fledged implementation; 3) be fair in its assessment of the quality of care provided to home health patients and incorporate pending OASIS changes, as well as a mix of multiple process and outcome measures; 4) refrain from negatively affecting patient access to care; 5) be consistent with the home health PPS and appropriately risk-adjusted; 6) limit any expansion of data collection requirements and fully reimburse agencies for the costs of any additional data collection requirements that are imposed; 7) only reward or penalize agencies for care elements over which they have some control; 8) reward high scoring agencies as well as those that demonstrate improvement for the dynamic value of home health services to the entire Medicare program; 9) not pose cash flow difficulties for agencies, with the incentive pool not to exceed 2 percent of home health payments; and 10) allow the Secretary of Health & Human Services sufficient discretion to delay application of value-based purchasing if implementation concerns arise.

Stay tuned to NAHC Report for further coverage of the 2016 March on Washington.




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