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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

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

NAHC Submits Comments on the Proposed Cardiac Bundle Model

October 6, 2016 02:23 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. (See NAHC Report, September 2, 2016.)

The National Association for Home Care & Hospice submitted the following comments expressing concerns regarding CMS’ plan to implement additional bundled episode payment models without fully evaluating the effectiveness of the CJR model.

Overall, NAHC is highly supportive of innovations in Medicare that improve access to care, enhance the quality of health care services and patient care outcomes, and institute efficiencies in Medicare spending. Medicare is one of the most valuable public programs in the country and should operate in the best interests of present and future Medicare beneficiaries. With the expected growth in Medicare spending related to the aging baby boom generation, innovative approaches to care and the financing of that care should be explored thoroughly. The proposal by the Centers for Medicare & Medicaid Services (CMS) to institute a pilot program that essentially “bundles” payments for  acute myocardial infarction (AMI), coronary artery bypass graph (GABG),  and surgical hip/femur fracture treatment (SHFFT) episodes, collectively referred to as episode payment models (EPMs), is a positive step in that direction. At the same time, we support CMS’s recognition that innovations be approached carefully to ensure that there are no unintended adverse consequences.

In line with such caution, NAHC recommends that CMS delay the implementation of the new EPMs until it has evaluated the impact of the Comprehensive Care for Joint Replacement (CJR) model to determine whether these new payment models will actually achieve CMS’ intended goals to improve efficiencies in care delivery and increase quality of care for Medicare beneficiaries.

Although bundle payment models may work to create efficiencies in health care delivery they can also encourage negative behaviors by the entity(s) that bears the financial risk, such as stinting on care; a delicate balance that CMS has expressed concern over in both this proposed rule and with the initiation of the CJR model. Therefore, it perplexing why CMS would go forward with plans to create and test three new episode payment models that will impact a significant number of Medicare beneficiaries and health care providers without clear evidence of the effectiveness of these models.

CMS has relied on other models and demonstrations currently and previously conducted by the Center for Innovation, such as, the Bundle Payment in Care Improvement (BPCI) model and the Medicare Acute Care Episode (ACE) demonstration to inform them on the EPMs.  However, an important distinction is that participation in the other models and demonstrations is voluntary, while the proposed EPMs require mandatory participation by both the beneficiary and the entity bearing the financial risk. This difference significantly limits the comparison between the models or the ability of one model to inform the performance of other model.

CMS proposes to take remedial actions if an EPM participant or its related EPM collaborators, collaboration agents or downstream collaboration agents fails to comply with any applicable requirements or is identified as noncompliant. Monitoring is to be through HHS, including CMS and the Office of Inspector General. However, CMS does not outline how it plans to monitor providers for compliance other than through claims review for changes in utilization patterns.  Meaningful claims data required for oversight of the EPMs will not be available for years after the model has been implemented. In addition, utilization patterns measure only one aspect of compliance.

CMS should delay the EPMs until such time that CMS has sufficient data from the CJR model to support whether implementing additional bundled payment models is appropriate. Lessons learned and evidence from the CJR model should inform CMS on the future construct of any EPM. Additionally, CMS should develop a robust compliance monitoring program to test on the CJR model that monitors claims data, cost reports, quality measures for all Part A and Part B providers, beneficiary complaints, and includes a schedule for medical record audits.

Realizing the CMS may choose to go forward with implementing the proposed EPMs, NAHC attached the comments submitted in response to the proposed rule for the CJR. In light of the similarity in the structure of the two models, the concerns for home health agencies for the EPM are the same as were for the CJR model.




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