Proposed changes that would cut Medicare reimbursement for clinical pastoral education programs have met with resistance from not-for-profit hospital systems that say a lack of funding would exacerbate an existing shortage of hospital chaplains.
In proposed regulations published May 19 in the Federal Register, the Centers for Medicare and Medicaid Services calls for reimbursements only for continuing education programs that offer certification in healthcare specialties, while eliminating Medicare funding for offerings that provide only training and no certification, such as clinical pastoral education.
"The pot of money is not changing; it is a clarification of what kinds of programs are eligible," a CMS spokeswoman said.
There are no tallies on the amount of funding the pastoral education programs currently receive. That amount is included in funding for nurses and allied health programs, which averages from $200 million to $225 million annually, according to the CMS.
The Association for Clinical Pastoral Education, Decatur, Ga., represents 350 hospitals and healthcare systems that offer internships and residencies in the pastoral-care field. The association is urging members to write the CMS opposing the rule change.
The association is trying to boost the number of hospital chaplains in smaller cities, which are reporting shortages, said Teresa Snorton, the group's executive director. She did not have an estimate on the chaplain shortages because individual hospitals oversee pastoral-care programs, she said. "People gravitate toward the urban areas," she said. "We are trying to increase the numbers."
The CMS is accepting public comments through July 8 and plans to respond to each before publishing final regulations on Aug. 1.
Premier, which represents 1,500 not-for-profit hospitals, has submitted a letter to the CMS requesting a change in the proposed regulations. In the June 19 letter, Premier cited the expenses that not-for-profit hospitals undertake in offering pastoral education training and called for "reasonable costs reimbursement" under Medicare.
"This has a long, rich history that goes back to the 1980s," said Herb Kuhn, corporate vice president of Premier and author of the letter to the CMS. "Now we are seeing an about-turn in this regulation."
Snorton's association has an approved training curriculum and requires internships and residencies for board certification as a chaplain, he said.
The Rev. Michael Place, president and chief executive officer of the Catholic Health Association, which represents 2,000 hospitals and systems, is preparing a letter opposing the reimbursement change, he said.
"The proposed rule will reverse 50 years of progress in the healthcare field," Place said. "Clinical pastoral education prepares people to be certified to provide spiritual care in a healthcare setting. It is recognized as having a beneficial, therapeutic effect on patients."