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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

CMS Releases Medicaid Managed Care Final Rule

April 27, 2016 09:24 AM

On Monday, April 25, the Centers for Medicare & Medicaid Services (CMS) finalized a major rule that focuses on Medicaid managed care related to minimum operation standards, care delivery, quality of care, and more.  The rule is of significant interest as more and more states move their Medicaid programs into one form or another of managed care. Further, since the rule also addresses Medicaid Managed Long Term Services and Supports (MLTSS), it is of specific interest to the home care community.

“We’re taking a next step in [our] work today by finalizing a long-anticipated rule that updates how Medicaid works for the nearly two-thirds of beneficiaries who get coverage through private managed care plans. These improvements modernize the way these managed care health plans operate so that Medicaid and CHIP continue to provide cost-effective, high quality care to consumers,” Andy Slavitt, Acting Administrator of CMS, and Vikki Wachino, CMS Deputy Administrator and Director for the Center for Medicaid and CHIP Services, wrote in a blog post announcing the final rule.

The National Association for Home Care & Hospice (NAHC) has long advocated for the institution of federal standards to govern states shifting from a traditional fee-for-services (FFS) approach in Medicaid to a managed care delivery model.  As states increasingly shift to managed care, the need for such standards has grown since managed care plans have limited experience in providing the type of services, particularly personal care, that are the mainstay of MLTSS.

The central feature of the MLTSS guidance in the rule is the codification of the 10 elements that CMS included in its 2013 guidance regarding MLTSS.  NAHC worked with both the diverse provider and beneficiary communities on the development of this “pro-home care” guidance.

CMS sets out in formal regulations that an MLTSS program must be evaluated to determine if it has the following:

  1. Adequate Planning: The states must use a deliberative process and maintain state monitoring and accountability relative to the development of, transition to, and operation of MLTSS.
  2. Stakeholder Engagement: States must go beyond the standard Medicaid Care Advisory Committee with a structure for engaging stakeholders regularly in ongoing monitoring and oversight of MLTSS programs.  The proposal uses a flexible “sufficiency” standard rather than setting quantitative parameters.  The key on stakeholder engagement is for the stakeholders to push the states to permit engagement.
  3. Enhanced Provision of Home and Community Based Services: This maybe the most important part of the MLTSS proposed rule.  It requires that the MLTSS programs be implemented consistent with the Americans with Disabilities Act and the Supreme Court’s 1999 decision in Olmstead v. L.C.  Experiences to date indicate that CMS is very serious about this element, requiring states to assure that plans favor home care over institutional care.
  4. Alignment of Payment Structures and Goals: The plan must be designed to support community integration and reduce costs.  It is hoped that this provision will limit managed care plans’ efforts simply to reduce costs to gain profits.
  5. Support for Beneficiaries: This would include choice counseling services, enrollment and disenrollment assistance, and advocacy support services.  Also, it includes creating an access point for complaints and concerns, education on grievance and appeal rights, assistance to beneficiaries in handling appeals, and ongoing state oversight on systemic issues.  CMS also includes authority for beneficiaries to dis-enroll from a plan if the beneficiary’s provider leaves the MLTSS plan network.
  6. Person-centered Process: A standard feature for CMS in all MLTSS areas: The design is to help achieve the greatest level of independence for the beneficiary.
  7. Comprehensive Integrated Service Package: It is intended that the state and the plan coordinate all functions needed for a successful delivery of services.
  8. Qualified Providers: This is a combination of provider credentialing and adequate access to care requirements.  CMS does not spell out what each must be in quantitative terms.  Instead, CMS sets out certain areas that states must develop standards.  For example, certain provider types must be available within state-defined time and distance standards.  Other components include a requirement that the state specify minimum factors in developing the standards such as the expected enrollment size.  CMS suggests, but does not mandate the use of enrollee-to-provider ratio standards in MLTSS.  Overall, significant flexibility is afforded the states in establishing access standards.  Some states have addressed access standards by allowing beneficiaries to continue with an existing provider for a period of time and permitting plans to establish limited networks of providers after the transition period closes.  However, CMS does indicate that a beneficiary with the power to choose the provider albeit from whatever limited network the plan ultimately offers.
  9. Participant Protections: This requirement is all about grievance and appeals processes and adequate communications.
  10. Quality: As usual, the quality standards are vague and leave virtually all discretion to the state Medicaid programs.  CMS does provide that three principles must be adhered to—Transparency; Alignment with other systems of care; and Consumer and Stakeholder Engagement.

After the rule was proposed in July 2015, NAHC submitted comments with several recommendations for improving the rule, including specifically requiring states and contractors to develop plans to comply with the Americans with Disabilities Act (ADA) and the U.S. Supreme Court decision in Olmstead v. L.C. (see previous NAHC Report article here).

NAHC is reviewing the 1,425-page final rule to determine the extent to which it provides a solid framework for establishing MLTSS, with preference given to home and community-based care. Stay tuned to NAHC Report for further analysis.




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