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NC Peds News Net -- February 2019

Monday, February 25, 2019  
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NCPeds News Net
February 2019

Medicaid Provider Rate Increase!

The NC Pediatric Society has advocated consistently for increases in the rates paid by Medicaid. Our leadership heard from you (and knew from their own experiences) that Medicaid rates were low and that the increased administrative burden likely under managed care risked imposing a substantial financial strain on providers. Together with the NC Academy of Family Physicians, we repeatedly emphasized the particular need to increase primary care rates in the context of the move to managed care. We highlighted the need for rate increases as a key point in virtually all of our Medicaid white paper responses and more than 30 meetings with representatives from the NC Department of Health and Human Services (NC DHHS).


In December 2018, NC DHHS announced a substantial Medicaid rate increase for primary care. While the State Plan Amendment to make this happen is still in process, the increased rates are anticipated to be retroactive to Jan. 1, 2019. A summer 2019 time-frame is expected for the payments to begin.The total increase (across all types of services) is estimated to be close to $60 million per year.


DHHS is able to implement targeted rate increases as long as they can do so under existing budget constraints. Due to strong fiscal management, the Department is able to implement the rate increase during this fiscal year.


Previously, North Carolina’s Medicaid rates for Evaluation and Management codes were approximately 75 percent of the rate paid by Medicare. Primary care physicians and other primary care providers as defined under the Affordable Care Act (plus a few others related to obstetrics) will soon see their rates increase to Medicare or near Medicare rates. Importantly, it is our understanding that the vaccine administration rates will stay at the regional maximum. As currently proposed, providers wouldnotneed to attest to receive the increased rate.


This rate increase will establish the rate floor in Medicaid managed care.


We would like to thank NC DHHS Secretary Dr. Mandy Cohen, Deputy Secretary Dave Richard, and many others in the Department for their work on this important rate increase!


For more information: Public Notice.




Winter Open Forum 2019

Our Winter Open Forum in January was a fantastic day filled with excellent speakers and attendees! Thanks to everyone who joined us in Winston-Salem for this packed event.



AAP Legislative Conference
Alison Gardner, MD, FAAP
Wake Forest Baptist Health


NCPeds Advocacy Opportunities
Representing NCPeds in Raleigh

When Alison Gardner attended her first American Academy of Pediatrics Legislative Conference in Washington, D.C. in 2018, she didn’t realize the impact it would have on her or pediatrics.


“The topic of this conference was gun violence. I realized that my stories...the horrible ones that I carry close to my heart and are not suitable to share with most…found a purpose at this conference. The toddler shot in the head, the suicides...all the gun victims that I had cared for in their last moments of life.... could find a voice in this conference,” she said. “I told these stories--as only one who had been there can--to our legislative leaders.The follow-up ask for help and partnership for better gun legislation and control becomes easy after sharing these stories.”


She plans to attend the 2019 AAP Legislative Conference where she looks forward to partnering with her colleagues from across the nation to help bring awareness to the issues facing children and pediatrics.


“By far the highlight (of the previous meeting) was meeting pediatrician leaders as we advocated together with our leaders in Washington. It was a beautiful picture to see 400 pediatricians taking to the Hill for this purpose,” she said. “I believe that this is what makes pediatrics separate and special from other specialties...we are advocates for patients who can't advocate for themselves.”


Alison is an Assistant Professor of Pediatric and Emergency Medicine at Wake Forest Baptist Health in Winston-Salem where she works in the pediatric emergency department. She is a graduate of Purdue University and the Indiana University School of Medicine.


She lives in Winston-Salem with her family. Outside of work, you can find her attending one of her children’s cross country, swimming or violin events. Her family also enjoys hiking, camping and caring for their chickens and bees and their backyard vegetable garden.


We have multiple advocacy opportunities available in the next few months. We invite all of our members to join us for these upcoming events to help us continue to improve the health, well-being and future of N.C.'s children and adolescents.

2019 Spring Open Forum

Join us April 6, 2019 at the Hilton Garden Inn Crabtree Valley in Raleigh for a day of networking and education. We'll be covering topics including:

  • Role of the physician in the political process
  • Access to sub-specialty care in Medicaid managed care
  • Updates from the General Assembly
  • Hosting a legislator in the home district

We'll also have an Advocacy Panel, breakout sessions and more.

Earlybird registration for the Spring Open Forum ends March 29. Register here.

White Coat Wednesday

Join NCPeds on May 15, 2019 at the N.C. General Assembly where we'll be talking directly with our state's leaders about the issues most affecting children and adolescents.

The day begins with an overview and briefing provided by the N.C. Medical Society where you'll receive an update on hot topics, tips fortalking with legislators and a layout of the legislative buildings.

Join us May 15 for this important day of advocacy! More information is available on our website.


Dates to Remember

Mark your calendars for these upcoming NCPeds events.

Special Note to our Members

Remember your NCPeds dues are tax deductible as you file your 2018 taxes!


Contact NCPeds



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