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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


June 27, 2016 07:02 PM

The proposed changes to home health prospective payment rates are within NAHC’s expectations given the 4-year phase-in of rate rebasing that started in 2014. CMS is capped at reducing the base episode rate by no more than $80.95 which is equal to 3.5% of the 2010 base rates. The proposal imposes such a cut offset by the annual Market Basket Index (MBI) and the annual Productivity Adjustment which started in 2015. While the proposal does not reference the 2% sequestration, it is definitely expected that such will continue in 2017.

The proposed MBI is 2.8% offset by the Productivity Adjustment (labeled by CMS as “private nonfarm business multifactor productivity” or MFP) required under the Affordable Care Act. In 2017, the adjustment is proposed at 0.50% leaving the update at a net of 2.3%. The case mix creep adjustment of 0.97% factored along with the MBI adjustment. CMS estimates that Medicare spending on home health services in 2017 will be $180 million less than would occur without the adjustments.

The proposed base episode rate for 2017 is set out at $2936.65. In contrast, the 2016 base rate is $2965.12.

CMS proposes to recalibrate the case mix weights again in 2016, leading to a budget neutrality adjustment of 1.0062. As such, an apples to apples comparison between 2016 and 2017 is not easily done. CMS estimates that the net result of all of its rate proposals is a $180 million reduction in Medicare payments to home health agencies in 2017.

The rate rebasing also affects LUPA payment rates. Those rates will rise 3.5% through rebasing and an additional 2.3% through the annual inflation update. Non-routine medical supply rates are also downwardly adjusted through the rebasing by a factor of 2.82 percent offset by a 2.3% MBI. The NRS conversion factor drops from $52.71 in 2016 to $52.40 in 2017.

No further case mix creep adjustment is proposed beyond the current 3-year reduction of 0.97% annually through 2018.

With respect to outlier payments, CMS proposes significant changes. Based on an analysis that shows outlier episodes have more, but shorter visits, CMS proposes to change to a cost per visit approach based on 15 minute service units. This change would mitigate the current disincentive to treat medically complex patients that require extended visits. CMS proposes to keep the same 80% loss ratio, but would increase the Fixed Dollar Loss Ratio from 0.45 to 0.56. This would have the effect of reducing the number of episodes that qualify for outlier payment. CMS indicates that such a change is needed to keep outlier spending within the 2.5% spending limit. The overall changes will have a distributional impact with some HHAs receiving higher outlier payments due to the nature of their patient service time utilization. CMS proposes to cap a day of service unit at 32, the equivalent of 8 hours.

The 3% Rural Add-On continues in 2017 along with the 2% rate reduction for HHAs that fail to comply with the quality data submission requirements that involve OASIS and HHCAHPS.

Detailed rate tables are available in the proposed rule.

CMS offers an analysis on the impact of rate rebasing. Overall, that analysis conveys that the rate cuts have not been deep enough to bring reimbursement in line with costs of care. MedPAC shares that view and has recommended another round of rebasing. To support that contention, CMS explains that since rebasing began in 2014 that the average number of visits per episode is down (lowering the per episode cost). On the other side of the equation is that the number of HHAs is down slightly since and the number of users is also slightly down, which CMS explains is due to the reduction in hospital and SNF discharges.


The Home Health Value Based Purchasing (HHVBP) program gets some important updates. Among them are:

  • Establishing a minimum of 8 HHAs as a cohort for measure application
  • Removing 4 measures that had not been fully developed that include care management; prior function; influenza vaccine data collection; and reason pneumococcal vaccine not received
  • The reporting periods are adjusted
  • Timeframe for submitting New Measure data is increased
  • A progress report on the HHVBP public reporting development
  • The institution of a formal appeals process

The HHVBP is estimated to save Medicare $378 million in reduced spending for inpatient hospitalization and SNF stays.

While CMS is moving forward with a proposed VBP pilot, an effort to legislate VBP in all of post-acute care is going on as well. At this point, available information indicates that the two governmental forces are not moving in tandem. That will make for a very interesting health policy dynamic to see what model prevails ultimately. Nevertheless, the signals are very clear that VBP is a contender for serious payment reform in Medicare.


CMS also is including some technical clarifications in a few existing rules along with updates on the quality data measures used to avoid the 2% rate penalty.

One notable miscellaneous item is the proposal relative to payment for disposable negative pressure wound treatment devices (NPWT). This proposal implements a change in the law from earlier this year that permits coverage of disposable negative pressure wound devices similar to coverage of the current DME none disposable version. Under the proposal, the payment for the NPWT would be outside of and separate from the home health payments. If the patient requires skilled nursing care for the “sole purpose” of NPWT, the visits will be reimbursed under Medicare Part B without a home health benefit payment. If the patient requires other Medicare-covered home health nursing services, the time spent on NPWT will be excluded, but will be separately covered under Part B. These services/equipment are subject to a 20% coinsurance.


Overall, the rule is a combination of expected rate proposals and a tweaking of the Value Based Purchasing pilot program. However, HHAs should pay particular attention to the changes in outlier payment and the new NPWT benefit impact on home health services.




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