Vaccine Reimbursement Will Come Within the Year

The NC Division of Medical Assistance (DMA/Medicaid) has decided not to appeal the Superior Court’s decision that they must rectify the underpayment of Medicaid vaccine administration payments made in 2013 and 2014. Superior Court Judge Beecher R. Gray did revise his order allowing DMA until November 2018 to reprocess the claims. The original order gave DMA 120 days to reimburse practices the $6.74 per affected vaccine.

The North Carolina Pediatric Society and the North Carolina Academy of Family Physicians (NCAFP) along with eight member practices filed suit seeking to correct underpayment of administration fees on approximately half of the vaccines provided to Medicaid patients under the Vaccines For Children (VFC) program. During 2013 and 2014, all vaccines given under the VFC Program should have received the higher administration fee under the Affordable Care Act. The underpayment affected approximately 2.5 million vaccinations in the state performed by health departments, FQHC’s, pediatricians, and family physicians.

The North Carolina Medical Society (NCMS) once again congratulates the NC Pediatric Society and the NCAFP for this important legal victory on an issue that the NCMS and the other organizations have all long advocated to correct.


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