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Testimonials

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. 

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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.

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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

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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 element...it’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

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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.

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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.

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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.

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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.

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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.

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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.

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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. 

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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.

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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.

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Frank E. Moss, former U.S. Senator

Anyone working on health care issues in Congress knows the name Val J. Halamandaris.

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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.

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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.

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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.

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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.

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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.

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Former President Bill Clinton

CMS Issues Plans for Pre-Claims Review for Home Health Agencies  

June 9, 2016 11:48 AM

The Centers for Medicare & Medicaid Services (CMS) has posted in the Federal Register  a Notice announcing a 3-year Medicare pre-claim review demonstration for home health services in the states of Illinois, Florida, Texas, Michigan, and Massachusetts where there have been high incidences of fraud and improper payments for these services.

The proposed demonstration will begin in Illinois not earlier than August 1, 2016, will begin in Florida not earlier than October 1, 2016, and will begin in Texas not earlier than December 1, 2016. The demonstration will begin in Michigan and Massachusetts not earlier than January 1, 2017. Providers in each state will be notified by the appropriate Medicare Administrative Contractor (MAC) prior to the start of the demonstration in the state.

The details of the demonstration are still not clear. However, CMS seems to be moving away from the concept of a “preauthorization” demonstration, that was originally proposed, to a “pre- claim review” demonstration where the agency will submit a pre-claim review request to receive a determination regarding eligibility  and coverage before submitting a claim. The main driver for the demonstration remains efforts to reduce improper payment related to insufficient documentation.

Under this demonstration, CMS states the home health agency (HHA) “will be encouraged to submit to the relevant MAC a request for pre-claim review, along with all relevant documentation to support Medicare coverage of the applicable home health level of service.

After receipt of all relevant documentation, the MAC will review the pre-claim review request to determine whether the service level complies with applicable Medicare coverage and clinical documentation requirements.” For initial reviews, CMS plans to instruct the MACs to make all reasonable efforts for a determination and issue a notice of the decision within 10 business days.

If the MAC declines payment after review, the agency may amend and resubmit the review request an unlimited number of times. For subsequent pre-claim review requests, the MAC will conduct a “complex medical review” and will be expected to make all reasonable efforts to have a decision within 20 business days.

It is unclear what documentation CMS will be requiring and reviewing for the pre- claim reviews and how, or if, the initial review will differ from subsequent reviews. CMS specifically states that a “complex medical review” will be conducted for the subsequent reviews, but implies it for initial reviews.

If an agency submits a claim for payment without a pre-claim review decision, CMS will apply a 25 percent payment reduction for claims deemed payable. In addition, HHAs that have had a pre- claim decision, must submit the pre-claim review number on the claim in order to avoid a 25 percent payment reduction.

CMS will process a Request for Anticipated Payment (RAP) submitted by the agency so services may begin while waiting for the decision on the pre-claim review request. There is no indication, in the Notice, that agencies must request a pre-claim review within any specific time frame as long as it is prior to submitting the claim.

The National Association for Home Care & Hospice (NAHC) has several concerns with the pre-claim review demonstration. CMS’ failure to take a targeted approach to the demonstration is one of those concerns. CMS could design a more manageable and meaningful demonstration by targeting agencies at risk for improper payment rather than casting a broad net over the entire state. In addition, the burden associated with a 100% pre- claim review program will be significant for agencies. Furthermore, the increased workload for both the agencies and MACs will undoubtedly result in delayed payments.

Although the pre-claim demonstration might provide agencies with an opportunity to correct technical errors prior to submitting a claim, medial review for sufficient documentation to support medical necessity and evidence of homebound has always been very subjective and inconsistently applied by the MACs. “Sufficient documentation” that CMS insists is lacking in HHAs medical records, causing high rates of denials, will remain at issue until CMS sets clear standards that all parties can understand and agree upon.

NAHC will keep its members up-to-date with any developments and the next steps we plan to take for addressing the CMS home health pre-claim review demonstration.

 

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