August 20, 2012
Deborah Patterson knows health ministry. As the executive director of Northwest Parish Nurse Ministries and author of Health Ministries: A Primer for Clergy and Congregations, she works daily with parish nurses, pastors, and health professionals. In this feature, she answers your most pressing or perplexing questions on health ministry. Are you hitting a roadblock with a program in your church? Are you wondering where to start with health ministry? Do you feel like you need a new idea on a specific topic? Ask Deborah!
QUESTION: Can faith community nurses be paid for their work by insurance?
ANSWER: The short answer is no, but to explain takes a little longer. Clearly, what faith community or parish nurses do is of value. Studies have shown that they are able to positively influence changes in the personal health practices of significant portions of their congregations, reduce readmissions to hospitals when they are involved in pre-discharge planning meetings, and help extend longevity by promoting active involvement in aiding others through their faith communities. So, you would think that this would be something that insurers would want to cover, because it costs less to keep people well through the types of health promotion programs that parish nurses offer than it does to pay for medical treatment to manage chronic illness. Not so simple.
Most nurses in this country are reimbursed for their services by insurance (usually indirectly through an hourly wage or salary from their health care employer) for providing a nursing service ordered by a doctor. Nurse practitioners operating under the scope and standards of practice for that specialty or RNs in private practice offering holistic nursing or complementary healing modalities can receive insurance payments—but more about that later.
Parish nurses can be paid a salary or a stipend by the congregation or other entity that has engaged their services, but the church isn’t able to receive payments for health care services from an insurer. This remuneration to the RN would be based on hours worked (typically between 10–20 per week), or a flat amount for the stipend per month or year. Parish nursing is not a fee-for-service model; parishioners do not pay the faith community nurse for services rendered, just as they would not pay a parish priest or pastor for making a pastoral visit. This is a service of the congregation—free to all.
If this ministry is financially supported, it should be done so by the entire congregation through tithes and offerings. This is not to say that a congregation or a parish nurse should not seek outside funding. Many congregations have found grant funding to help with the start-up of a program (or to implement a particular program, such as Mental Health First Aid). As you are aware, however, grant funding ends, and each church needs to budget for picking up the costs to continue the program.
Some parish nurse networks have found government funding (generally through a health department) to offer programming in partnership between churches and communities. One example of this was the Beauty and Barbershop Initiative that funded health education around stroke risk factors and warning signs in Missouri. Faith community nurses connected with stylists and barbers in their neighborhoods to share with them information about the risk factors for and warning signs of stroke. They also left materials that could be shared with their clients. This was funded through a grant from the state’s Department of Health.
Other parish nurses have proposed to legislators in their area (such as Oregon) that states allow tax credits for hours worked as a faith community nurse. To the best of our knowledge, this has not yet been implemented in any state. However, other parish nurses have addressed this differently by financially supporting the congregation, which then pays them the same amount back. This way they are able to take a tax deduction for their contribution at the level. While they don’t receive a deduction equal to the full amount they are paid, it does give them some reimbursement for their service, and does not cost the church anything to administer other than the regular tracking of a parishioner’s gifts to the church that they would be doing for anyone who contributes financially to the congregation.
Now, back to the private practice question. This is the only possible loophole for insurance reimbursement to a parish nurse. Mary Amdall Thompson, RN, MS, CNS, who served as a program executive for professional services at the Oregon Board of Nursing and answered scope of practice questions from all levels of licensees, addressed this question related to private practice as a holistic nurse. She stated that nurses with a private practice in holistic nursing, who provide complementary therapies and healing work,
… may be eligible to receive third party reimbursement, depending on what the insurance policy for your client covers and the insurer’s evaluation of your authority to provide the service. It is common for insurance companies to call the Board to inquire about the nursing scope of practice as it relates to a particular function. In the case of complementary therapies, the Oregon Board of Nursing believes that these are within the Registered Nurse scope of practice and have adopted a position statement.
She is clear, however, that nurses must review the Nurse Practice Act for their state, the scope and standards for their specialty practice, administrative rules, and position statements or policy statements on activities adopted by your state’s Board of Nursing. The National Council of State Boards of Nursing website contains more information to connect with your state Board of Nursing.*
In addition, if your faith community nursing practice was to be a private practice that could receive insurance reimbursement for services, Thompson states, “there are rules related to those entities for which you may need the services of an attorney to guide you. In some states, your licensing board may require that you register with the Board as well as follow other rules for incorporation.”*
The bottom line, however, is that this is not really a private practice that you set up on your own. It is exactly the opposite. It is a congregational practice that was called forth by the congregation within the congregation. The categorical imperative to provide the same services to all without regard to reimbursement must take precedence. Therefore, I urge you to work with your congregation to make this a paid professional leadership position within your faith community for the good of all.
However, let me add just one caveat. Some faith-based organizations, such as retirement communities or daycares, have faith community nurses, and these might be the places to test the model for insurance reimbursement for services provided. If you are working in such a location, talk with your administrator about possible options for applying for reimbursement for services.
* Source: “Considering Private Practice as a Holistic Nurse? What You Need to Know” from the Alternative Journal of Nursing. Accessed on-line at http://www.altjn.com/archives/1.asp