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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

Heath 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

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

CMS Proposes A Mandatory Cardiac Bundled Care Initiative

September 2, 2016 01:33 PM

On August 2, 2016, the Centers for Medicare & Medicaid Services (CMS) issued the proposed rule: Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR). The propose rule outlines the structure  for a bundled payment project for acute myocardial infarctions (AMI), coronary artery bypass graphs (CABG), and adds surgical hip/femur fracture treatments (SHFFT) to the CJR bundled initiative that went into effect April 1, 2016.

The EPMs under the proposed rule have the following key elements, many of which are similar to the CJR bundled project.

  • A five year project to begin July 1, 2017–December 31, 2021;
  • Hospitals bear the financial risk;
  • The episode begins with a hospital admission and ends 90 days after discharge from the hospital;
  • Includes the cost for all Medicare Part A and Part B items and services related to the respective condition for the episode;   
  • Hospitals may have collaborative arrangement with other providers to share in the risk that includes home health agencies;
  • Requires mandatory participation for hospitals and beneficiaries in selected Metropolitan Statistical Areas (MSAs);
  • Sets a target price for each episode of care;
  • Includes reconciliation payments to hospitals that stay under the target price for a performance year and requires hospitals to repay Medicare for costs that exceed the target price for the performance year;
  • Includes quality performance metrics for reconciliation payments;
  • Includes waivers for the SNF 3 day rule, direct physician supervision, telehealh origination site and geographic location, certain post operative payment restrictions, and allows NPPs to furnish for cardiac rehabilitation and intensive cardiac rehabilitation services. CMS explicitly stated it does not plan to waive the homebound requirement for home health services;
  • Provides for home visits by the physician or the physician’s staff to non-homebound beneficiaries;
  • Includes beneficiary notice requirements;
  • Retains beneficiary freedom of choice for services and providers, although hospitals may recommend preferred providers.

The National Association for Home Care & Hospice (NAHC) believes these EPMs will have similar benefits and draw backs for home health agencies (HHAs) as the CJR initiative. Hospitals will be looking to partner with cost efficient post-cute care providers. Home health care is the least costly of all post-acute care settings, with home health agencies continually rising to the challenge of caring for sicker and frailer patients.

CMS, in the proposed rule, noted that beneficiaries with episodes of care for AMI, CABG and hip/femur fractures commonly have chronic conditions and have high hospital readmissions rates.

Agencies that can demonstrate effective episode management and good quality outcomes for these patients should be proactive in working the local hospitals and physicians to develop relationships as preferred providers, with or without a formal collaborative arrangement. Among the data to share  should be re-hospitalization rates and emergency room visit rates; the disciplines required and the number of home health visits per discipline typically required for  patients admitted to home health post-AMI, CABG, and hip/femur fractures.

This is also important because in addition to promoting efficiencies and care coordination, bundled projects can also incentivize risk bearing entities to curtail services in order to decrease costs.

Under the CMS bundle projects, Medicare payment to providers remains unchanged. Therefore, HHAs will be paid according the home health prospective payment system for participating Medicare beneficiaries. The hospital may not negotiate a rate or choose to pay per visit. However, referral source can control cost for home health services by limiting utilization of services.

NAHC is already hearing from home health agencies in the CJR areas that only four therapy visits are being approved for beneficiaries with the conditions affected by the CJR bundle; most likely to keep the episode paid at a low-utilization payment adjustment rate rather than a full episodic payment. The beneficiary, therefore, may not be getting all of the services they are entitled to, such as, skilled nursing for medication reconciliation and home care aide services.

HHAs that are aware of some of the advantages and pitfalls of these bundled projects will be better positioned to establish relationships with referral sources and hospitals to ensure that high quality home health care is provided to all Medicare beneficiaries.

Comments on the proposed rule are due Oct. 3, 2016.




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