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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

MedPAC Recommends an Accelerated Implementation of PAC PPS

April 19, 2017 03:45 PM

The Medicare Payment Advisory Commission (MedPAC), the congressional advisory body on Medicare payment policy, is recommending that Congress legislate the establishment of a single prospective payment system for all post-acute care services, otherwise known as PAC PPS.

Under the ImprovingMedicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), MedPAC was ordered to analyze whether a PAC PPS could be developed, what it might look like, and how it would be implemented. Over the last 18 months, MedPAC has been working on that project and in a June 2016 report MedPAC advised that PAC PPS was doable.

In its most recent PAC PPS recommendations, finalized by the commissioners on April 7, MedPAC indicates that PAC PPS should be implemented sooner rather than later -- as early as 2021. Furthermore, MedPAC recommends that Congress consider phasing it in, possibly through a payment system blending in the first years. In addition, MedPAC recommends that PAC PPS include authority to immediately reduce most PAC payment rates and to rebase rates to achieve average cost reimbursement.

The proposed PAC PPS would rely mostly on existing data already obtained by home health agencies, skilled nursing facilities, long term care hospitals, and inpatient rehabilitation facilities. Hospice is not included in PAC PPS. MedPAC believes that in doing so, the institution of PAC PPS can and should be accelerated. While many details of the PAC PPS are glaringly absent, MedPAC is clear that home health services can fit within it simply by reducing the payment rates for care in institutional settings to account for the lower cost of services.  MedPAC recommends the use of the same case mix adjustment model for all four sites of post-acute care with payment amounts being site-neutral, except that home health would get less than institutional care because room and board is not a Medicare-covered cost in the patient’s home.    

NAHC has numerous concerns with the MedPAC proposals.

First, experiences are strong that there are cost factors present in home health care that are not present in the controlled setting of an institution. For example, home health agency care is often, but not always, supplemented by informal caregivers such as family and friends. Travel time and travel costs also affect the cost of home health services while those costs do not exist in institutional care. Notably, MedPAC does not offer guidance on how to calculate the home health post-acute care payment rates. Instead, it simply refers to its opinion that home health services costs less, its recommendations to cut payment rates by 5% in 2018, and its March 2017 recommendations to rebase rates to average costs.

Second, the PAC PPS would also significantly redistribute payments away from patients receiving therapy services and towards patients with high nursing needs. The impact of such a change is not fully known, but past experiences indicate that care access will be affected for the therapy patient populations.

Third, MedPAC has not addressed whether the PAC PPS model would also apply to home health patients who have not entered into care by way of a prior inpatient hospital stay. Currently, more than 50% of the Medicare-covered home health episodes of care involve community referral rather than post-acute care.

The IMPACT Act does not mandate the institution of a PAC PPS, nor does it authorize Medicare to do so by way of regulation. Congress would have to pass legislation to do so. As such, there will be opportunities for NAHC and other stakeholders to voice their views on the proposal.

The MedPAC public hearing documents and a transcript of the April 7 proceedings is available at  A comprehensive report to Congress on PAC PPS is expected in June.




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