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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 Open Door Forum Provides Home Health, Hospice Updates

July 18, 2016 08:50 AM

The Centers for Medicare & Medicare Services (CMS) conducted a Home Health, Hospice and Durable Medical Equipment (DME) Open Door Forum on July 13. A summary of home health and hospice issues are provided below.


2017 HHPPS Rate Update Proposed Rule. CMS provided the following overview of 2017 home health rate update proposed rule:

The proposed rule implements the final year of the four year phase-in of the rebasing adjustments to the national, standardized 60 day episode payment rates, the national per-visit rates, and the non-routine medical supplies (NRS) conversion factor. In addition, this proposed rule would reduce the national, standardized 60-day episode payment rates by 0.97 percent in CY 2017 to account for nominal case-mix growth between CY 2012 and CY 2014. The CY 2017 proposed rule would result in a 1.0 percent decrease (-$180 million) in payments to HHAs. CMS is also proposing changes to the methodology used to calculate outlier payments from a cost per visit to a cost per unit model. As required by the Consolidated Appropriations Act of 2016, CMS proposes changes in payment for disposable Negative Pressure Wound Therapy (NPWT) for patients under a home health plan of care. The Act requires CMS to pay for the NPWT separately and equal to payment made under the hospital outpatient prospective payment system. CMS also proposes an update to the Home Health Quality Reporting Program (HHQRP). Lastly, in addition to providing an update on the progress towards developing public reporting of performance under the Home Health Value Based Purchasing model (HHVBP), CMS proposes several changes and improvements related to the model.

  • HHVBP. CMS proposes the following changes and improvements to the model:
  • Removes the following four the quality measures, beginning for the 2016 reporting year
    • Care Management: Types and Sources of Assistance Prior Functioning ADL/IADL
    • Influenza Vaccine Data Collection Period: Does this episode of care include any dates on or between October 1 and March 31
    • Reason Pneumococcal Vaccine Not Received
  • Requires annul reporting and submission of the influenza vaccine measure rather than quarterly.
  • Increases the time frame to submit new measure from 7 calendar days to 15 calendar days
  • Calculates performance benchmark and achievement threshold based on the state level rather than cohorts
  • Defines a small-volume cohort for performance comparison and calculation of payment adjustments as having a least eight HHAs 
  • Adds an appeals process to the total points score and payment adjustment to include a request for recalculation and reconsideration.
  • Outlines the process for public reporting of performance related to HHVBP 

CMS officials announced that agencies should expect to receive their first interim performance report this month. Agencies may access the report through the HHVBP secure portal. CMS will be hosting a webinar on the performance reports on July 28 at 2pm. Agencies can obtain information and register for the webinar by going to the HHVBP connect site. 

HHQRP. The presenters provided an overview of several proposed changes to the HHQRP.

CMS proposes to eliminate 28 measures, and add the following four new measures as required by the IMPACT Act.

  • Drug Regimen review conducted with follow-up – OASIS
  • MSPB
  • Discharge to community
  • Potentially preventable 30 day post discharge readmission

Also in the proposed rule, CMS listed eight new measures under consideration for home health agencies.  

The policy for public reporting of measures adds a review period and correction process prior to measures posting on Home Health Compare.

IMPACT Act. The presenters also addressed stakeholder engagement opportunities related to the IMPACT Act and encouraged participants to view the CMS IMPACT Act web site. One such opportunity occurring in July is the field testing of standardized data elements among post acute care (PAC) providers to test the validity of the standardized data elements and the feasibility of collecting the items in all four PAC settings. CMS also announced that it plans to conduct webinars related to the IMPACT Act activities every 8 weeks.


Hospice Payment Reform/Claims Processing Update. Claims processing staff provided an update on issues that have emerged since the two-tiered payment system for Routine Home Care (RHC) and the Service-Intensity Add-on (SIA) were instituted on January 1, 2016. These claims processing issues may be reported in your Medicare Administrative Contractor’s (MAC’s) Claims Issues Log. Four problems have surfaced; they are described below along with the scheduled plans to address them:

First, CMS received reports that the Common Working File (CWF) did not always identify prior hospice days that should have counted toward the episode day count. This occurred when a revocation posted prior to the final claim coming in. As a result, hospices were receiving the high RHC rate for some days for which they should have been receiving the lower payment rate. A revision to the system was implemented on May 9 and hospices should no longer be experiencing this problem.

A second issue has been occurring in the Fiscal Intermediary Shared System (FISS) system where FISS is not always using the correct date to start the episode of care day count if a previous period of hospice care was recorded. At times FISS used the start of a previous benefit period to begin the count rather than using the current benefit period (when a 60-day period had intervened). The result is that too many days are being included in the current episode of care so providers are being underpaid. A correction to this error is scheduled for July 25, after which the MACs will adjust the claims.

Two additional issues related to claim processing under the new hospice payment system are scheduled to be addressed in January 2017 (a Change Request addressing these will be issued during the first week in August). The first issue relates to circumstances under which systems are not applying all days from multiple prior benefit periods in the day count for the episode. The second issue relates to payments for the end-of-life SIA payments for certain claims. While changes to correct both of these problems have been completed by the MACs, the changes did not fully address the problems, so additional changes must be made.

Hospice CAHPS.The Hospice CAHPS survey website is:; technical questions related to the survey may be directed to the CAHPS Hospice Survey Project Team at or by calling 1-844-472-4621.

Notices for non-compliance with CAHPS survey requirements affecting the FY2017 payment year have been mailed to hospice providers; if a hospice has received a notice of non-compliance and wants to request a reconsideration, please follow the instructions contained in the letter. The deadline for filing the recondition request is Friday, July 29. The following recommendations were stated:

First, as part of your reconsideration request, DO provide evidence that your hospice is compliant. If you need guidance on such information please contact the Technical Assistance team.

Second, DO include the correct CCN or provider number on your request; otherwise there will be problems with processing of your reconsideration request.

Finally, DO NOT include protected health information (PHI) or personal information about patients with your reconsideration request. These are a violation of HIPAA and CMS is required to report agencies that perform such violations.

CAHPS Exemption for Size.The CAHPS Hospice Exemption for Sizeform for 2018 APU is now available on the CAHPS Survey Website and will remain available until August 10, 2016, which is the deadline for submission. You MUST submit a request to have CMS consider giving you an exemption for size. Be sure to use the correct CCN with your exemption request and submit your form as soon as possible. 

A list of CAHPS Hospice vendors is available on the CAHPS Hospice website. Please stay in touch with your vendor and make certain that they are submitting your data in a timely fashion. Successful submission includes acceptance of your records by the data warehouse.

Deadlines for submission/acceptance of CAHPS data are the second Wednesday of February, May, August, and November. CMS recommends that your monitor your vendor for performance as you would any investment -- the quality of vendor performance varies. CMS cannot accept late CAHPS data submissions, and it is the hospice that will be penalized. A hospice may gain access to the data warehouse so that it can monitor activities of its vendor on behalf of the hospice, and CMS recommends that hospices take advantage of this opportunity.

Hospice Quality Reporting Program. Between June 15 and 29 CMS sent notices related to non-compliance with the quality reporting requirements for the FY 2017 APU. Hospices receiving such notices have the opportunity to submit a request for reconsideration. Please view the following web site for more information on requesting reconsideration:​iatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Reconsideration-Requests.html.

 A New Hospice Data Directory is now available on ; this directory includes information on all hospices certified by Medicare and high level demographic data for each agency. Establishment of the data directory is CMS’ first step toward public reporting for hospice providers. CMS is currently actively developing a Hospice Compare website, which should be ready by mid-2017. CMS’ plans are for Hospice Item Set (HIS) measures to be posted on the Compare site, and eventually will post CAHPS and other data there. Hospice providers should check to ensure that data related to their agency is correct and report any errors to the regional office coordinator.

HIS Data Submission Specifications (v2.00.0) are NOW available in draft form in the DOWNLOADS section at the bottom of the HIS Technical Information page. These specifications go into effect April 1, 2017.

A New Hospice Timeliness Compliance Threshold Report will be available beginning July 17, 2016 in the CASPER Reporting Application. This report will allow hospice providers to determine how well they are meeting the new timeliness requirement that 70% of CY2016 submissions are accepted by the deadline. 


Following is a summary of questions and answers related to hospice issues that were posed during the Open Door Forum:

Hospice Claims Processing Issues. One caller requested a written claims processing update related to hospice payment reform processing issues. CMS staff indicated that most of the MACs should have updates included under their Claims Issues Logs. A Change Request related to some corrections will be available during the first week of August; additionally, staff offered to include an article on outstanding payment reform issues and their status in a forthcoming edition of CMS’ Thursday E-news.

Hospice CAHPS. When will group share calculation of how hospice CAHPS measures will be scored? CMS staff indicated that the final decision on this issue has not yet been made.

Hospice and HH CAHHPS.A participant asked is CMS would be willing to make available the number of clients (providers) per state are covered by each vendor as that may be an indicator of vendor usefulness to providers? A CMS CAHPS representative said that CMS will look into that, but suggested that the number of providers used per state will not be a determinant of the quality of work that the vendor does. CMS’ Office of General Counsel is currently looking at what information CMS can make available related to vendors.




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