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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

CMS Must Withdraw the Proposed Home Health Groupings Model

September 8, 2017 02:36 PM

CMSGO HERE to ask Congress to tell CMS to stop this proposed payment rule.

The Centers for Medicare & Medicaid Services (CMS) CY2018 Proposed Rule for the Home Health Agency (HHA) Prospective Payment System includes the Home Health Groupings Model (HHGM), a policy that must be withdrawn because it will cause massive disruption in the industry and its reduction in Medicare reimbursements of almost $1 billion in 2019 alone will lead to a loss of critical services to millions of patients.

At a time when federal policy continues to support care in the most cost-effective settings, like home health services, HHGM is a counter-productive and significant obstacle to delivering the type of quality care that Medicare beneficiaries need in their home. The HHGM is a wholesale payment reform measure that would replace a 17-year payment model in a non-budget-neutral fashion with dramatic and wide-ranging affects at the provider level. For example, the HHGM bases payment amounts on an untested model that relies on certain patient characteristics that have not been determined to be valid or reliable indicators of care needs. It would also replace the tested 60-day episodes model with 30-day “periods,” even though Medicare retains a 60-day standard for the patient assessment and plan of care. This change conflicts with CMS’ efforts to reduce administrative burden by requiring providers to bill twice as frequently and manage patient care in a framework inconsistent with the payment system.

Thus, in several ways, the new proposed HHGM works against the stated goals of CMS and a cut of approximately five percent of the annual Medicare spending on home health could be a devastating payment model.

HHGM would:

  • Create access to care barriers for vulnerable home health patients;
  • Significantly cut reimbursement for many types of home health patients without Congressional authorization;
  • Compound five years of rate cuts that total nearly 18% in a benefit that has had essentially flat spending since 2010; and
  • Impose non-budget neutral reforms in home health services at a level that previously caused significant harm to patients, e.g. with the Interim Payment System (1998-2000), nearly 1.5 million Medicare beneficiaries lost access to care following the closure of more than 4,000 home health agencies virtually overnight.

The HHGM would redistribute payments away from medically-necessary home health services such as physical therapy, occupational therapy and speech-language pathology that are currently producing Medicare savings in innovative value-based care, alternative payment systems and bundled payment models. In the long run, HHGM could result in higher Medicare costs as patients are forced to access institutional care rather than receive appropriate care in their own homes.

The process of developing the HHGM was opaque, with only vague details provided despite industry’s repeated requests for input and data. Worse still, the proposed rule itself does not provide enough information to accurately assess its potential impact. The table below highlights the information necessary to fully assess the impact and

provide meaningful comment on HHGM as proposed – much of which were not included in CMS’ proposed rule:

Information Needed to Fully Assess Impact

Included in Proposed Rule or Supplements?

CY16 Claims and OASIS Assessment Data


CY 2017, 2018, and 2019 (under HHGM) HH baseline


Explanation for how CMS treated 60-day episodes with no visits day 31+


Description of “behavioral assumptions”, other factors included in impact estimates


Case Mix Weights


LUPA thresholds


Outlier threshold


ICD-10 codes associated with clinical groupings, comorbidities


Functional status thresholds



What CMS needs to do is:

  • Withdraw the HHGM as part of the HHA CY2018 Final Rule;
  • Revise the HHGM so it is budget-neutral;
  • Initiate a partnership with industry and stakeholders to design a payment model that supports patient-centered, quality-driven care;
  • Phase in a different HHGM over multiple years, starting no earlier than 2020.

This untested HHGM is likely to have an unpredictable and harmful impact on millions of patients and the providers who serve them and reducing Medicare payments by nearly $1 billion annually can only trigger problems in accessing and delivering care. Patients will likely lose access to home care as providers will be paid less than the cost of care. CMS should withdraw this proposal and work with stakeholder groups to ensure that a new model is developed and implemented thoughtfully, without hindering access to care.

Therefore, CMS must withdraw this proposal and work with stakeholder groups to ensure that a new model is developed and implemented thoughtfully, without hindering access to care.

This issue is NAHC’s top priority and will remain so until the policy is improved. Please stay tuned for further analysis and news about NAHC advocacy on behalf of our members and the millions of aged and disabled Americans they serve.

However, to defeat this payment rule before it brings havoc to the industry, we need home health leaders, employees and patients to make their voices heard by policymakers in Washington, D.C. Without your support and advocacy, this rule cannot be stopped. Please go to the NAHC Legislative Action Center and ask Congress to tell CMS to withdraw the payment rule.




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