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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

Medicare Home Health Pre-claim Review Project a “Complete Mess”

September 1, 2016 09:45 AM

Forecasts of dire consequences stemming from the recently initiated Medicare home health pre-claim review (PCR) project in Illinois are turning out to be highly accurate. Medicare Administrative Contractor (MAC) PGBA along with CMS Central Office have shown that preparation is falling far short of what is needed to handle simple tasks, such as setting up a reliable documentation submission system. Endless reports of the MAC losing documents submitted electronically led to a CMS recommendation that home health agencies (HHAs) resort to antiquated fax submissions. Those fax submissions faired no better.

“It is a complete mess,” explained Bill Dombi. NAHC’s Vice President for Law. “That is the result that we all predicted given the magnitude of the undertaking that increased the MAC’s claim review workload 40-50 times of its normal volume,” he added.

HHAs report the following with respect to document submissions:

  • “it is taking us an hour for each submission”
  • “documents go through, but PGBA says they are illegible when received”
  • “can not start a PCR, save and finish later”

However, the most serious PCR problems go beyond the handling of submitted documentation. In a “Chat Room” discussion sponsored by NAHC and the Illinois Home Care Council, with over 100 home health companies participating, it has become clear that the MAC will reject a high proportion of pre-claim reviews on the basis that the patient is not homebound or that the care is not necessary. These “on the merits” decisions are creating a serious “chilling effect” among veteran home health agencies across the state. With chat room reports of an 80% rejection rate, agency executives indicate that they plan to withhold the start of care until a favorable pre-claim review decision is issued. It can be expected that access to care problems will escalate in the very short term unless CMS and the MAC reverse course quickly. Comments such as the following are growing:

  • “a local hospital based agency who decided, in part, to close its doors rather than participate in PCR”
  • “our experience is a 4-7 days delay in service”
  • “we are also getting non-affirmations on knee replacements”

The high rate of rejection is compounded by the uninformative reasons given by the MAC in the rejection notice. While the primary intent of the project is the help correct alleged documentation deficiencies, conclusory statements such as the “patient is not homebound” offer no guidance to home health agencies seeking to take corrective actions. However, it may not be possible for the MAC to provide better guidance, as the HHAs report that the rejected claims involve patients with a clear homebound status and need for the physician-ordered care.


As the PCR tragedy continues to unfold, NAHC is taking the following steps designed to suspend PCR in Illinois and prevent its expansion into the other four targeted states, Florida (October 1); Texas (November 1); and Massachusetts and Michigan (January 1):

1.     Heightened congressional PCR advocacy on our behalf. At this point, numerous congressional officials have communicated their concerns to CMS. Another round of bipartisan, bicameral action is in process as Congress returns to work next week. The threat to care access that have surface in actuality rather than theory will drive that engagement. With Congress returning to work, the option of a legislative fix exists, albeit with great difficulty in a year focused on the elections and backlogged work on the budget.

2.     Enlistment of the patient advocacy community. As a member of the Leadership Council of Aging Organizations, NAHC has reached out to numerous patient advocacy groups to enlist their support in rescinding PCR. This is a highly patient impacting project, as HHAs begin to withhold care as a result of PCR rejections.

3.    Development of real-time impact data. NAHC and the Illinois Council have developed a PCR data toll that is in use by the Illinois home health agencies, providing uniform real-time data on the business and patient impact of PCR. The tool’s use will be expanded to the other affected states beginning in October if PCR is not rescinded.

4.    On-going HHA communications. Each Thursday, NAHC and the Illinois Council are holding Web-based “chat rooms” for HHAs to present up-to-the-minute PCR experiences, problems, and potential solutions. NAHC and the Illinois Council will issue notices of the upcoming chat sessions.

5.    Open lines of communication with CMS.Medicare officials have established a weekly conference call discussion with NAHC in order to stem any operational problems and gain an understanding of HHA/patient impact. NAHC has also been in communication with the CMS Office of the Administrator with the request to suspend the project.

6.    Development of a lawsuit challenging the project’s validity and authority.Litigation is always a last resort. With respect to PCR, litigation needs support of evidence of harmful impact. Unfortunately, that means that any lawsuit must wait for the harm to surface in order to present a compelling case in court. With PCR, that harm is just beginning to emerge, as it has taken a few weeks for HHAs and the MAC to reach the first stage of PCR determinations.

Stayed tuned to NAHC report for further updates on PCR. Please send information about PCR experiences and difficulties to




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