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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

OIG Releases Report on Hospice Election Statements and Certifications of Terminal Illness

September 16, 2016 04:05 PM

The Office of Inspector General (OIG) has released new study called Hospices Should Improve Their Election Statements And Certifications Of Terminal Illness.  The motivation for the new study came about because “previous OIG work has raised concerns that some election statements used by hospices are misleading and that physicians are sometimes not involved in care planning and may rarely see beneficiaries. Also, OIG has investigated numerous cases in which hospices submitted fraudulent claims for patients who were not appropriate for hospice care.” 

The election statement and certifications of terminal illness (CTI) from an OIG study conducted on the general inpatient (GIP) level of care in 2012 were used for this study.  A total of 563 election statements were reviewed.  Hospices are responsible for creating their own Medicare election statement, and the election statement requirements are the same regardless of the patient’s level of care as are the CTI requirements. 

The OIG findings, and recommendations based on the findings, are below.

Election Statements:

One-third of GIP stays lacked required information or had other vulnerabilities.

Percentage of GIP Stays With Election Statements That Lacked Required Information or Had Other Vulnerabilities

Election statement did not specify Medicare


Required waiver information was missing was stated inaccurately


Required information about palliative care was missing


Revocation or discharge information was inaccurate or unclear



NAHC and its affiliate, the Hospice Association of America, suggests hospices

  • ensure their election statements specify that the patient is electing the Medicare hospice benefit,
  • specify the Medicare coverage waived,
  • explain the difference between palliative and curative care in the election statement or specifically reference where this explanation can be found in materials presented to the patient prior to election,
  • clearly explain the patient’s right to revoke and transfer and the difference between these actions and a discharge in the election statement or specifically reference where this explanation can be found in the materials presented to the patient prior to election.     

The OIG recognized that part of the reason for at least the impact on the patient of revocation or discharge is that the regulations and the Medicare manuals used by hospices are not consistently clear about the requirements and/or the impact of the requirements on the patient.  The OIG seemed to hone in on two areas of the election statement – waiver of coverage of certain Medicare services and the palliative rather than curative nature of hospice care – as the most problematic.  The OIG also acknowledged that hospices can include more than what is required in the election statement; however, this may confuse beneficiaries. 

Certifications of Terminal Illness

In 14% of the GIP stays reviewed, the physician did not meet requirements—such as composing a narrative—when certifying that the beneficiary was terminally ill and appeared to have limited involvement in determining that the beneficiary was appropriate for hospice care. This and other findings appear in the table below.

Percentage of GIP Stays With CTIs That Did Not Meet Requirements

Percentage of GIP stays for which the physician did not meet requirements when certifying and appeared to have limited involvement in determining that the beneficiary was appropriate for hospice care


Percentage of GIP stays for which the certifying physician did not include a narrative at all or included only the beneficiary's diagnosis


Percentage of GIP stays for which the certifying physician did not include an attestation



NAHC and the HAA suggest hospices:

  • Ensure the physician narrative of the CTI is completed and includes a summary of the clinical findings that depict the patient’s terminal prognosis (i.e. statement of a diagnosis is not sufficient)
  • Ensure there is an attestation statement on the CTI and the physician as signed it

Based on the study’s findings, the OIG recommended the following to CMS with CMS concurring with three of the four recommendations.  The findings, and CMS’ response, are listed below.

OIG Recommendations and CMS Response



CMS should develop and disseminate model text for election statements

CMS concurs with this recommendation, acknowledges that hospices are allowed to develop their own election statements, and that it will develop sample text that can be used by hospices in their election statements.

CMS instruct surveyors to strengthen their review of election statements and certifications of terminal illness

CMS concurs with this recommendation and will change surveyor training to include the proper emphasis on the election statements and CTIs.

CMS should educate hospices on election statements and certifications of terminal illness

CMS concurs and will work with the Medicare Administrative Contractors (MACs) and through CMS publications to issue guidance to providers.

CMS should provide guidance to hospices regarding the effects on beneficiaries of revocations and discharges

CMS did not concur or not concur.  It simply indicated that it will monitor revocations and discharges and provide guidance to hospices, if necessary.


The full OIG report can be viewed from the link at the beginning of this article.  NAHC and HAA are working on further analysis of this report and will provide additional detail, as well as helpful resources, in the future.  Please watch NAHC Report for additional information.




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