The North Carolina Pediatric Society (NCPeds)and the North Carolina Academy of Family Physicians (NCAFP)have been advocating for the NC Division of Medical Assistance (DMA) to correct an underpayment on administrative fees for immunizations provided to Medicaid and NC Health Choice recipients.
The Affordable Care Act (ACA) increased vaccine administration fees. However, it appears that only about half of the vaccines provided to Medicaid and NC Health Choice recipients during the 2013 – 2014 were paid the higher fee of $20.45.
After lengthy discussions urging NC Medicaid to correct these underpayments proved unsuccessful,NCPeds and NCAFP joined several large pediatric practices to retain a lawyer and undertake official administrative action. Through our attorney for this matter, Joey Ponzi with the Brooks Pierce law firm, we have taken two significant steps. First, we submitted a Request for Declaratory Ruling, which requires Medicaid to issue a formal ruling as to its position on the appropriate payment level.Second, we filed a Contested Case Petition with the Office of Administrative Hearings, directly challenging NC Medicaid’s refusal to reprocess the vaccine administration claims for 2013 and 2014.
While we hope that NC Medicaid will agree and reprocess the claims appropriately, we remain ready and willing to pursue both official administrative actions to assure appropriate past payment for our members who put appropriate vaccination delivery, patient health and public health above reimbursements.
Special thanks are due to the several physicians, especially Dr. Graham Barden whose analysis based on careful reading of various State Plan Amendments, the Federal Register and the ACA is the basis for the claim filed.
Winter Open Forum
It was a capacity crowd for the Winter Open Forum in Carrboro! We would like to thank the more than 100 people who helped to make the event a success.
Meet the Board
Dr. W. Scott St. Clair
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In August 2016, W. Scott St. Clair began a two year term as the President of the North Carolina Pediatric Society.Scott has been an active member of the board for many years and is looking forward to serving as President of the society.
“It is an honor to serve as President of the Pediatric Society.One of the key functions of the Pediatric Society is to give a voice for children and their families to those who hold political power.I am always energized when I work with pediatricians across the state who are advocating for the health of kids in our state.”
Scott, who earned an undergraduate degree in Political Science from Duke University, attended the Medical College of Georgia, and completed his Pediatric Residency at Children’s Hospital of Cincinnati.He is currently a partner at Blue Ridge Pediatrics and Adolescent Medicine in Boone, NC where he has worked for fifteen years.
A native of Atlanta, Scott and his wife, Cameron, now reside in Boone with their three children: Price (17), Blane (14) and Virginia (12).Outside of work Scott enjoys hiking and cycling, especially on North Carolina’s beautiful Blue Ridge Parkway!
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