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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

CMS Conducts Pre-Claim Review Demonstration Special Open Door Forum

June 17, 2016 08:47 AM

The Centers for Medicare & Medicaid Services (CMS) held a Special Open Door Forum call on June 14 for the home health Pre-Claim Review Demonstration project. In addition to what has already been addressed in the Notice that was issued in the FR, CMS provided a list of items that will be required for a pre-claim request and addressed participants’ questions.

CMS began the call by stating that the Pre-Claim Review Demonstration was an attempt to reduce fraud in the home health industry and reduce improper payments related to insufficient documentation that has been increasing over the last few years.

The demonstration is planned for three years 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.

According to the CMS officials, the home health agency (HHA) will submit a pre-claim review request to their MAC with the following information:

  • BeneficiaryName, Medicare Number (also known as HICN), Beneficiary Date of Birth, and Beneficiary Gender
  • Certifying Physician/Practitioner Name, National Provider Identifier (NPI), PTAN (optional), and Address
  • Home Health Agency Name, National Provider Identifier (NPI), PTAN (optional), and Address
  • RequestorContact Name and Telephone Number
  • Other Information
    • Benefit period requested (initial or subsequent),
    • Submission Date,
    • From and Through Date of the episode,
    • Indicate if the request is an initial or resubmission review,
    • State where service is rendered.

CMS clarified that the request may be sent anytime prior to submitting the final claim, even prior to the start of care.

Agencies should submit all documentation and information that supports medical necessity, similar to what is require for an additional documentation request (ADR). The documentation may be submitted via fax, mail, through the contractor portal, or electronically.

A tracking number referred to the UTN will be assigned when the initial request has been reviewed even if the request in not affirmed. The UTN must go on the final claim to demonstrate a pre-claim review has occurred. When submitting an electronic 837 institutional claim, the UTN should be submitted at Loop 2300, segment REF/G1/02. When submitting a paper CMS 1450 Claim form, the UTN should be submitted in Form Locator 63.

If the initial request is not affirmed the contractor will send a letter to both the provider and the beneficiary describing the reason(s) for the decision. The request may be resubmitted as many times as necessary.

CMS officials stated that claims affirmed through pre-claim review will not be subject to further medical review, except for CERT and ZPIC contractor reviews.

Agencies that do not request a pre-claim review will be subject to a 25% reduction in payment if the claim is paid. In addition, agencies that fail to submit the UTN with the final claim will have payments reduced by 25%. CMS is providing a 3 month grace period from the 25 % reduction beginning from the time the demonstration is initiated in each state. 

CMS expects to begin the demonstration in Illinois on August 1, 2016, in Florida on October 1, 2016, in Texas December 1, 2016, and in Michigan and Massachusetts on January 1, 2017.

CMS has set-up a dedicated website for the Pre-Claim Review Demonstration. Question regarding the demonstration may be sent to CMS also plans to have a draft of the Operation Guide available for public comment by June 28.

A transcript and audio recording of this Special ODF will be posted to the Special Open Door Forum website for downloading at:

CMS is planning another Pre-Claim Review Demonstration Open Door Forum Call for June 28.

Summary of the Q&A session

  • One participant commented on the increased staff time that will be needed to submit the request and documentation for claim.
  • A caller asked if CMS would remove providers from the demonstration if proven to be compliant and not at high risk. CMS does not have plans for such at this time.
  • A participant commented that locator 63/Loop 2300 is currently used for the OASIS matching key and asked if both numbers will be in this location? CMS stated they will need to consult others at CMS before responding.
  • Will the demonstration apply to beneficiaries under Medicare Advantage Plans? CMS stated that the demonstration only applies to Medicare Fee-for-Service beneficiaries.
  • A caller expressed concern regarding the ability for the contractors to handle the increased work load and provided an example. In Florida there are 1,300 agencies. If each agency submitted just one claim for review that would equal 1, 300 requests. CMS responded by saying that they are aware of the numbers and are confident the contractors are ready for the Pre-Claim Review Demonstration.
  • One caller asked if the demonstration applies to recertification episodes or only the start of care. CMS confirmed that the demonstration applies to all claims submitted by the agency which includes recertification episodes.
  • A caller asked whether adding a service, once an affirmed review was received, would impact the decision. CMS responded no, the decision would not be affected by adding a service.
  • A caller questioned if the Request for Accelerated Payment (RAP) process would be impacted. CMS responded that there would be no change to the RAP process.  
  • One caller asked if the POC, as part of the review, needed to be signed by the physician. CMS could not provide an affirmative answer to this question. 



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