To order CommunityCARE program materials, click here.

Non-Medicaid providers must enroll in Medicaid before they can become CommunityCARE or KIDMED Providers. Non-Medicaid providers should contact the Unisys Provider Relations unit at 800-473-2783 or 225-924-5040 to request a Medicaid enrollment packet. Providers already enrolled in Louisiana Medicaid , who want to become CommunityCARE and/or KIDMED providers, should download the appropriate forms below in the format of their choice. All forms require an original signature. Completed forms should be mailed to the address below. Mailing of the completed forms to any other address will delay your enrollment.

For questions regarding certification issues, you may contact ACS at 225-231-8104. General questions regarding CommunityCARE policies and procedures may be directed to the Unisys Provider Relations unit at the numbers above.

CommunityCARE


PE-50 CommunityCARE Provider Supplement Agreement: This form is required by all Providers enrolling in the CommunityCARE program.
PDF Format • Word Document

Services Agreement: This form must be completed if you will be a CommunityCARE PCP providing acute care to children under the age of 21 and will be subcontracting KIDMED services to another Provider.
PDF Format • Word Document

Email to Provider Community:

From: Farrell, Billy B. (CMS/SC)
Sent: Thursday, June 18, 2009 8:16 AM
To: Blunt, Ford J. (CMS/SC); Reeder, Joe C. (CMS/SC); Rupley, Cheryl A. (CMS/SC); Harper, Scott S. (CMS/SC); Sullivan, Bobbie L. (CMS/SC); Branch, Jeoffrey A. (CMS/SC)
Cc: Brooks, Bill D. (CMS/CMCHO); Ferguson, Dorothy A. (CMS/CMCHO)
Subject: Opportunity to Provide Comments on Meaningful Use
Importance: High

___________________________________________________________________________________________________________

Dear Healthcare Provider,

On Tuesday, June 16th, 2009, the Health Information Technology (HIT) Policy Committee, a Federal Advisory Committee (FACA) to the U.S. Department of Health and Human Services (HHS), met to begin the process of defining "meaningful use" of electronic health records (EHRs), as related to the historic $19 billion investment to further the national adoption and implementation of
health information technology as part of the American Recovery and Reinvestment Act of 2009.

The American Recovery and Reinvestment Act of 2009 (the "Recovery Act") (Pub. L. 111-5) provides for Medicare and Medicaid incentive payments for eligible providers, such as physicians and hospitals, in order to promote the adoption of EHRs. To receive the incentive payments, providers must demonstrate "meaningful use" of a certified EHR. Building upon the work of the HIT Policy Committee, HHS anticipates developing a proposed rule that provides greater detail on the incentive programs and "meaningful use." HHS expects to issue the proposed rule in late 2009, which will be followed by a comment period.

The Committee released its first recommendations toward a definition of "meaningful use", representing extensive work by the Committee's Meaningful Use Workgroup to review and evaluate ideas and contributions from Workgroup members, along with information from a public hearing on meaningful use convened in April by the National Committee on Vital and Health Statistics (NCVHS). This meeting and these recommendations are a first step for HHS, as it investigates possible definitions for meaningful use.

The Office of the National Coordinator for Health Information Technology (ONC) is seeking comments on this preliminary definition of "meaningful use." Comments on the draft description of "meaningful use" are due by 5 pm EST on June 26, 2009, and should be no more than 2,000 words in length.

This is an important opportunity to provide your comments as the definition of "meaningful use" is being developed. These recommendations are the product of a sub-workgroup of the FACA committee, and are not legislation.

To view the Meaningful Use Matrix, please click on the following link:
http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11113_872719_0_0_18/Meaningful%20Use%20Matrix.pdf

To read the Meaningful Use Preamble, please click on the following link:
http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11113_872720_0_0_18/Meaningful%20Use%20Preamble.pdf

Electronic responses to the draft description of "meaningful use" are preferred and should be addressed to:
MeaningfulUse@hhs.gov
With the subject line "Meaningful Use"

Written comments may also be submitted to:
Office of the National Coordinator for Health Information Technology
200 Independence Ave, SW
Suite 729D
Washington, DC 20201
Attention: HIT Policy Committee Meaningful Use Comments

Please remember, all comments are due by 5 pm EST on June 26, 2009, and should be no more than 2,000 words in length.

For more information on the Office of the National Coordinator for Health Information Technology, please visit their website at http://healthit.hhs.gov

For more information on The American Recovery and Reinvestment Act of 2009, please visit http:www.recovery.gov

Thank you for your time.

KIDMED

PE-50 KIDMED Provider Enrollment Supplement Agreement: This form must be completed if you are providing acute care to children under the age of 21 and you intend to become a certified KIDMED Provider and provide KIDMED services at this practice location.
PDF Format • Word Document

Retainer Agreement Medical Director: This form must be completed if you are a non-physician and plan to operate a KIDMED screening clinic.
PDF Format • Word Document

Miscellaneous Forms

CommunityCARE Program Medically High Risk Exemption Form: This form should be completed by the enrollee and the enrollee's physican to request an exemption from the CommunityCARE program for medically fragile and high-risk enrollees.
PDF Format • Word Document

CommunityCARE Referral Form (revised June 2009): This form is used by CommunityCARE PCPs to refer their CommunityCARE enrollees for medically appropriate services the PCP does not provide (i.e.: specialty care, post authorizations of emergency services, etc…)
PDF Format