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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 Letter to CMS – Withdraw the Home Health Group Model

September 12, 2017 03:36 PM

Home_Health_Rate_CutsThe National Association for Home Care & Hospice (NAHC) and the Partnership for Quality Home Healthcare have written a letter to CMS Administrator Seema Verma, encouraging her to withdraw the proposed CY 2019 Home Health Groupings Model (HHGM) because the rule is likely to cause considerable disruption and possible loss of care for many home health patients.

The home health industry requires additional information in order to fully assess the impact of the proposed rule, with more complete data analysis, and scrutiny as to the legal and policy authority to make the rule, write authors William Dombi, President of NAHC, and Keith Myers, Chairman of the Partnership for Quality Home Healthcare.

CMS needs to convene a broader workgroup of stakeholders and, in consultation with these stakeholders, evaluate criteria that ensure that all the Medicare benefit is available to those who are eligible, and devote attention to educating all parties who order and provide the valued Medicare home health benefit. The sheer number of changes to the HH PPS incorporated in the proposed version of HHGM make current analyses of its impact difficult to adequately perform and would cause any unintended consequences of its potential implementation near impossible to isolate and address. We welcome the opportunity to engage with CMS on ways to craft rules that are “less complex” and “reduce burdens”, as stated in the Request for Information (“RFI”) contained in the proposed rule.

Specifically, Dombi and Myers ask for additional information on the following issues so that home health stakeholders can fully understand the impact of the proposals in the rule:

  • How will revenues be addressed that are associated with the 30-day episode periods that receive payment under the current HH PPS but would not be paid under the HHGM? The proposed rule states that the change to 30-day episodes means that home health agencies will be better compensated. The HH PPS law requires both budget neutrality and standardized payment.
  • The proposed rule states that Table 55 contains “assumptions on behavioral responses.” Do these behavioral responses assume that revenue shortfalls under HHGM will be made up by providers? If so, how? Is there a justification for the “assumptions on behavioral responses”?
  • It is unclear what the projected total system value would be under CY 2017, CY 2018 (under current law), and CY2019 with the HHGM changes. The proposed rule states that the total system value would be reduced by $950 million in 2019 if the final rule is fully non-budget neutral, or $480 million if the rule is partially non-budget neutral, with the total reduction still being $950 million when fully implemented. This type of an analysis is exactly the type of analysis that the RFI is concerned with because it is bureaucratic and complex, and requires additional clarification in order for its plain meaning to be understood by providers.
  • The HHGM data set was based on 2013 claims data1 and does not account for the full 14 percent reduction implemented through the Affordable Care Act. Has an analysis been conducted on the impact HHGM would have on access to services going forward? In the CY 2014 Home Health Prospective Payment System Update Rule, CMS estimated that “approximately 40 percent of providers will have negative margins in CY 2017.” We are concerned that the cuts proposed by CMS would be unsustainable for many providers, particularly those in rural areas that are already struggling to provide beneficiaries with continued access to a benefit they depend on.

Additionally, Dombi and Myers are also concerned that:

  • CMS does not have the authority to change the model of care as outlined in the statute and to do so in a non-budget neutral manner, and
  • Changing the standard episode of care from a 60-day to a 30-day episode is inconsistent with the statute.

What’s more, CMS continues to make assumptions that do not accurately estimate the financial impact of reductions in the home health payment. For example, when the original home health prospective payment was enacted, it was estimated to save $16.7 billion; however, it ended up reducing overall payments closer to $70 billion. More analysis in this area must be done and cannot be appropriately accomplished within the timeframe for the proposed rule.

Implementing a totally new payment system that significantly cuts Medicare home health, with virtually no input from the industry, puts both vulnerable home health beneficiaries and quality providers at significant risk.

“Medicare’s home healthcare benefit has long made clinically—and cost—effective services available to homebound seniors and disabled Americans,” write the authors. “These services allow senior citizens and individuals with disabilities to receive physician-ordered medical and rehabilitative treatment where they most prefer to remain: in the safety and dignity of their own homes.

NAHC urges CMS to withdraw the HHGM policyand instead work with stakeholders to develop a fully budget-neutral policy that does not limit access to beneficiaries or diminish provider resources.

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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