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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

NAHC Submits Comments on FY2017 Proposed Hospice Payment, Quality Regulations

June 24, 2016 08:28 AM

On April 21, 2016, the Centers for Medicare & Medicaid Services (CMS) issued Medicare Program; FY2017 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements (CMS-1652-P), the proposed Medicare hospice payment and policy rule for fiscal year (FY) 2017. Since that time, the National Association for Home Care & Hospice (NAHC) sought input and conducted numerous discussions with hospice stakeholders on aspects of the proposed rule, and submitted comments on June 20, 2016. Given that the FY2016 rule made significant payment and policy changes for hospice, it came as no surprise that the FY2017 proposed hospice payment rule placed most of its emphasis on next steps for the Hospice Quality Reporting Program (HQRP). In keeping with the content of the proposed rule, NAHC’s comments also place predominant emphasis on planned changes to the HQRP but also provide general comments related to hospice utilization and other trends discussed in the rule. Following is a summary of comments submitted by NAHC to CMS.

Hospice Utilization, Research and Analyses, Monitoring Payment Reform

NAHC notes in its comments that growth in utilization of hospice services has slowed dramatically and requests that CMS provide additional detail that helps to identify the cause(s) of this slowdown so as to determine whether access to care is being impaired. NAHC also requests information on outcomes related to CMS’ previously announced referrals of hospices to Program Integrity and other oversight bodies (these referrals were the result of data analyses conducted related to payment reform). NAHC also notes the significant increase in hospice claims submitted with multiple diagnoses and posits that this will likely continue to improve since the Hospice PEPPER now provides hospices agency-specific data on the percent of claims that they have submitted that include only one diagnosis.

CMS includes as part of the proposed rule discussion of hospice’s role in Medicare end-of-life spending (including pre-hospice spending) and spending outside of hospice while patients are on a hospice election.  CMS found that patients with the longest lengths of stay have lower pre-hospice Medicare spending than those on hospice service for shorter lengths of time, but that overall Medicare spending for these longer stay patients tends to be higher than spending for those on hospice care for a shorter period of time. NAHC points out in its comments that it is oftentimes more difficult to predict life expectancy for longer-stay hospice patients due to their terminal diagnosis (Alzheimer’s, neurological disorders), and prior to hospice service they likely receive a mix of services weighted heavily toward personal and supportive services, which are frequently financed privately or under Medicaid. With election of hospice care the patient is then eligible for coverage of some of these services as part of the bundle of covered services. NAHC also cautions against movement toward a case-mix based hospice payment system and expresses support for payment refinements that help to incentivize appropriate timing on enrollment for hospice. Further, NAHC expresses support for monitoring of the impact of payment reform on hospices with a high proportion of short-stay patients. If the most recent payment refinements are affecting these providers negatively, CMS should work toward addressing this. NAHC also underscores the need for advancements related to processing of Notices of Election and Notices of Termination/Revocation so that patient status on hospice care is recorded in the Common Working File (CWF) on a more timely basis.

Updates to the HQRP

NAHC expresses support CMS’ recognition of the importance of the variety of hospice disciplines as part of its measures pair “Hospice Visits When Death is Imminent”, but relative to the measure cautions against creation of an environment that drives unnecessary visits. NAHC recommends that bereavement coordinators and volunteers be included as part of the measures when it undergoes revisions and urges that CMS develop a definition of a visit (for purposes of these measures) that is somewhat different from the definition used for claims submission. This would mean that post mortem visits, social worker phone calls, and other services would be included as part of that definition. CMS would be required to make changes to the measure numerator but NAHC believes that it is warranted.  NAHC advises that any calculations made from these measures be risk-adjusted to reflect a patient and/or family’s right to decline visits in order to maintain privacy.

NAHC raises several issues related to the Hospice Item Set (HIS) Composite measure, including advising that the scores should be risk-adjusted to reflect patients that are on service for short periods of time. In such cases, hospices must have the freedom to prioritize response to immediate needs, and may not be able to deliver all seven care processes in instances where a very short length of stay ends in death. Further, NAHC is concerned that public reporting of the Composite measures without sufficient explanation of the difference between process and outcome measures could mislead consumers, and indicates it might be appropriate to wait to publicly report the Composite measures until such time as the Hospice CAHPS findings can be reported. NAHC also expresses support for the Medicare Payment Advisory Commission’s recommendations that CMS pursue hospice outcome measures and actively eliminate measures that are no longer considered good measures of quality of care.

In its comments NAHC generally supports plans to create a hospice comprehensive patient assessment instrument but asks that CMS seek stakeholder input on the instrument throughout its development. NAHC also encourages CMS to consider options for development of measures that reflect quality of care at different points across the length of stay rather than just looking at patient admission and discharge as is currently the plan. NAHC also expresses concern that the new instrument will likely be completed by skilled staff at the time of care delivery so cost estimates must take that into account.

NAHC also provides some comment on star ratings for hospice, urging that CMS not utilize a bell curve for ranking of hospice programs as this type of ranking is not generally understood by the public.

The full text of NAHC’s comments to CMS on the FY2017 proposed hospice payment rule is available here.




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