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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

House Energy & Commerce Oversight and Investigations Subcommittee Holds Hearing on Medicare and Medicaid Program Integrity

June 1, 2016 12:42 PM

The U.S. House of Representatives Energy & Commerce Oversight and Investigations Subcommittee held a hearing on Tuesday, May 24, 2016, titled, “Medicare and Medicaid Program Integrity: Combatting Improper Payments and Ineligible Providers.” In announcing the hearing, Subcommittee Chairman Tim Murphy (R-PA) highlighted estimates released by HHS that in 2015 there was $89 billion dollars in improper payments through Medicare and Medicaid—9.8 percent in Medicaid and 12.1 percent in Medicare fee-for-service. Members of Congress asked the witnesses to explain the rate of improper payments and what CMS is and should be doing to reduce the rate.

The hearing witnesses included Dr. Shantanu Agrawal, Deputy Administrator and Director of the Center for Program Integrity at the Centers for Medicare & Medicaid Services (CMS); Mr. Seto J. Bagdoyan Director of Audit Services, Forensic Audits and Investigative Service at the U.S. Government Accountability Office; and Ms. Ann Maxwell, Assistant Inspector General in the Office of Evaluation and Inspections, Office of Inspector General at the U.S. Department of Health and Human Services.

Dr. Agrawal attempted to address the concerns of the lawmakers by explaining steps CMS is taking to reduce improper payments. He also stated the difference between improper payments and fraud, and he argued that the driving cause of the improper payment rate is largely documentation problems. “The improper payment rate is driven by documentation problems,” he said. “Seventy percent of the rate is provider-driven documentation issues. That is, for example in the home health space, lack of coordination between the ordering physician and the home health agency.”

Dr. Agrawal noted that, in Medicare fee-for-service, home health services have had “particularly high improper payment rates in recent years” due to new documentation requirements. Most of these documentation problems are attributed to ongoing problems with the home health face-to-face requirements. In order to address these problems, Dr. Agrawal said, CMS is working to clarify the various requirements to improve compliance. “CMS believes clarifying requirements will lead to a decrease in these errors and improve provider compliance with regulatory requirements, while continuing to strengthen the integrity of the Medicare program,” he said. “To ensure providers understand the regulations and documentation requirements, CMS has implemented a probe and educate program for all home health agencies. This program reviews a small number of claims for every home health agency, identifies whether the reviewed claims complied with Medicare policies, and offers education to providers who require assistance in properly documenting home health claims.”

Rep. David McKinley (R-WV), who was among the 116 members of the U.S. House who signed the letter to CMS on the home health prior authorization demonstration, reiterated his concerns about the prior authorization demonstration during the hearing. He asked why the prior authorization demonstration has been instituted “across-the-board” rather than being more focused on those who have a history of “violating the system.” He also stated that currently “everyone is being punished,” which “doesn’t make sense.” Dr. Agrawal responded that he is “very open to a more focused prior authorization, really focused on bad actors and folks that have high denial rates,” but that “more experience” is necessary “before we get there.”

In explaining other steps CMS has taken to improve program integrity, Dr. Agrawal noted the enrollment moratoria on home health agencies in certain geographic locations with a disproportionately high number of providers and extremely high utilization rates. Since the moratoria was imposed in July 2013, he said, 848 HHAs in all geographic areas affected by the moratoria had their applications denied.

With regards to Medicaid, Dr. Agrawal said the improper payment rate has increased due to a lack of complete state compliance with new requirements under the ACA such as that all referring or ordering providers be enrolled in Medicaid and that states screen providers under a risk-based screening process prior to enrollment. He said, “While these requirements will ultimately strengthen Medicaid’s integrity, it is not unusual to see increases in improper payment rates following the implementation of new requirements because it takes time for states to make systems changes required for compliance.”

Given the acknowledgement by CMS that documentation issues are the driving force behind improper payment rates in Medicare, following the hearing the National Association for Home Care & Hospice (NAHC) called on CMS to explore alternatives to the current unmanageable face-to-face encounter documentation requirements given that early indications are that high error rates are continuing in the probe and educate audits. NAHC strongly believes that CMS must eliminate the current documentation requirements as they are fatally burdened by a lack of clarity and by holding the home health agency responsible for a physician’s documentation. NAHC also continues to pursue a legislative remedy to the face-to-face documentation nightmare with increasing bipartisan, bicameral support. CMS’s admission of ongoing documentation management problems in home health will help those efforts.




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