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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

Report: CMS’ Proposal Home Health Groupings Model Puts Entire Home Health System at Risk

September 13, 2017 03:53 PM

Home_Health_Rate_CutsThe Centers for Medicare and Medicaid’s proposed Home Health Groupings Model (HHGM) would cause enormous stress on the home health system, very possibly placing agencies in jeopardy and causing damage to beneficiaries, providers, and the post-acute care system, according to a new analysis from Dobson DaVanzo & Associates, a health economics and policy consulting firm based in northern Virginia.

Dobson DaVanzo & Associates was commissioned in early 2017 to replicate the impact of the HHGM patient grouper and model payment. The analysis finds that the HHGM “would fundamentally change how home health care providers are paid and, in turn, how they deliver care.

The proposed HHGM would end direct reimbursement for the number of therapy visits and instead base reimbursement directly on patient and case characteristics, such as admission source and episode timing, clinical grouping, functional level, and the presence of comorbidities. The proposed rule would also shorten home health episodes from 60 days to 30 days. (For a full description of what’s in the proposed rule, read this article by NAHC President Bill Dombi.)

The analysis concludes that “historically, when changes of this magnitude were implemented, the field experienced extreme financial distress,” noting that “changes of a similar scale have created unintended effects among agencies and beneficiaries.”

Changes to the home health system in the 1990s, remind the authors, that there was a net 15 percent reduction in the number of Medicare Home Health Agencies and utilization dropped by 29 percent from 1996 to 1999. Program payments fell from $16.8 billion in 1996 to under $ billion by 1999 and the industry did not recover until after 2007.

Dobson DaVanzo & Associates followed the Abt Associates Technical Report and used 2013 datato replicate the HHGM patient grouper and model payment impacts.

The analysis concludes that the HHGM is “highly redistributive of Medicare payments for home health services,” with 27 percent of HHAs experiencing “a revenue shit of at least +/- 20% for some cases under HHGM.” Over 40 percent of “HHAs serving ACO-attributed beneficiaries would experience a revenue shift of +/- 20% for the ACO-attributed case load under HHGM.” According to the analysis, the primary “drivers of the impact ratio are therapy provided, admission source (institutional vs. community), timing (early vs. late), and presence of comorbidities.

The report find that HHGM is an estimated 15% below budget-neutral on revenues, due to the exclusion of certain 30-day episodes which are currently paid under the 60-day system.

However, Dobson DaVanzo also notes that much of the impact of the proposed rule is difficult to predict because of “unclear or missing information.” For example, the HHGM does not explain what are the assumed behavioral response that would change what looks like a 15 percent reduction into a smaller 4.3 percent reduction. In addition, the HHGM was modeled using 2016 data, which is not yet publicly available.

Ominously, the Dobson DaVanzo analysis concludes that:

  • The HHGM represents a major shift from the current payment system;
  • The HHGM has the potential to significantly redistribute payments and revenues;
  • By setting costs equal to payments, the HHGM essentially rebases the system to a lower level;
  • Paired with the lack of budget neutrality, the HHGM would stress the system in compounding ways and potentially create unintended consequences;
  • Historically, changes of this magnitude have placed agencies in jeopardy, with negative impacts on beneficiaries, providers, and the post-acute care landscape

NAHC urges CMS to withdraw the HHGM policy and 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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