Family PACT

Clients

To stay informed with the latest available information on the COVID-19 developments and how it impacts Family PACT providers, please visit Family PACT’s COVID-19 page.

24/7 Free Medi-Nurse Call Line Launches for COVID-19 Questions

DHCS launched a free, 24/7 Medi-Nurse advice line to answer questions about COVID-19 for anyone who:

• Doesn’t have insurance, or
• Is a Medi-Cal beneficiary but doesn’t have a regular doctor or managed care plan to oversee their care.

The nurses who field the questions can help callers:

• Understand if symptoms might be related to COVID-19
• Determine whether they need to self-isolate
• Decide if they need to see a doctor to get tested and/or treated
• Connect with a Medi-Cal provider who can help determine presumptive eligibility for Medi-Cal

Medi-Nurse Call Line:  (877) 409-9052

About The Office of Family Planning and Family PACT

The Office of Family Planning (OFP) is charged by the California Legislature “to make available to citizens of the State who are of childbearing age comprehensive medical knowledge, assistance, and services relating to the planning of families”. The purpose of family planning is to provide people a means by which they can decide for themselves the number, timing, and spacing of their children.

OFP administers the Family Planning, Access, Care, and Treatment (Family PACT) program. Family PACT is California’s innovative approach to provide comprehensive family planning services to eligible low income (under 200% federal poverty level) residents. Family PACT serves 1.1 million income eligible Californians of childbearing age through a network of 2,200 public and private providers. Services include comprehensive education, assistance, and services relating to family planning.

News and Updates

Increasing Reports of Disseminated Gonococcal Infections (DGI)

In recent months, the California Department of Public Health (CDPH) has received increasing number of reports of disseminated gonococcal infection (DGI), an uncommon but severe complication of untreated gonorrhea. On November 5, 2020, CDPH issued a Dear Colleague Letter providing additional information about DGI in California.

In light of the increase in DGI cases, CDPH recommends the prioritization of routine screening, testing, and treatment of sexually transmitted infections (STIs) per the Centers for Disease Control and Prevention (CDC) guidelines. The Family PACT Program covers the diagnosis and treatment of specified STIs for Family PACT clients as clinically indicated, when care is provided coincident, or pursuant, to a family planning service in a family planning setting. For additional information, providers may refer to the following sections of the Policies, Procedures and Billing Instructions manual:

• Benefits Grid (ben grid)
• Benefits: Family Planning (ben fam)
• Benefits: Family Planning-Related Services (ben fam rel)

HHS Expands Provider Relief Fund Eligibility and Updates Reporting Requirements

The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is announcing the latest Provider Relief Fund (PRF) application period has been expanded to include provider applicants such as residential treatment facilities, chiropractors, and eye and vision providers that have not yet received Provider Relief Fund distributions. These providers and all Phase 3 applicants will have until 11:59PM EST on November 6, 2020 to submit their applications for payment consideration

List of Eligible Practices and Types of Providers:
Today, HHS is expanding the pool of eligible Phase 3 applicants to include providers across a broad category of practices. Many providers who accept Medicare and Medicaid within these categories have already received a PRF payment, but others have not and HHS is working to ensure even more providers are able to receive Phase 3 funding. The list below includes eligible practices where providers may now apply for Phase 3 funding regardless of whether they accept Medicaid or Medicare.

• Behavioral Health Providers
• Allopathic & Osteopathic Physicians
• Dental Providers
• Assisted Living Facilities
• Chiropractors
• Nursing Service and Related Providers
• Hospice Providers
• Respiratory, Developmental, Rehabilitative and Restorative Service Providers
• Emergency Medical Service Providers
• Hospital Units
• Residential Treatment Facilities
• Laboratories
• Ambulatory Health Care Facilities
• Eye and Vision Services Providers
• Physician Assistants & Advanced Practice Nursing Providers
• Nursing & Custodial Care Facilities
• Podiatric Medicine & Surgery Service Providers

Updated Reporting Requirements:
In response to concerns raised, HHS is amending the reporting instructions to increase flexibility around how providers can apply PRF money toward lost revenues attributable to coronavirus. After reimbursing healthcare related expenses attributable to coronavirus that were unreimbursed by other sources, providers may use remaining PRF funds to cover any lost revenue, measured as a negative change in year-over-year actual revenue from patient care related sources.

Links to Information:
Press Release.
Policy memorandum on the reporting requirement decision – PDF*.
Amended reporting requirements guidance – PDF.*
For updates and to learn more about the Provider Relief Program, visit: hhs.gov/providerrelief.

Trump Administration Announces $20 Billion in New Phase 3 Provider Relief Funding

The administration released $20B in Phase 3 of the Provider Relief Funds – deadline 11:59pm Eastern on November 6 – CMS recommends applying early.
Very important:
1. Providers who have already received funds can receive more funding– new opportunity to recover costs due to COVID as well as operating losses
2. Providers just starting practice in early 2020 are now eligible
3. New opportunity for a wide variety of mental health and SUD providers

CDC Dear Colleague Letter regarding Diagnostic Test Shortage (September 3, 2020)

Erroneously Denied Family PACT Claims for HCPCS Code T1014 with RAD Code 9516

The Department of Health Care Services (DHCS) has identified a claims processing issue that causes Family PACT claims billed for HCPCS Code T1014 (telehealth transmission, per minute, professional services bill separately) to be denied with Remittance Advice Details (RAD) Code 9516: The secondary diagnosis code is missing or invalid for the procedure code.

No action is required of providers. An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims. Providers should continue to submit claims in a timely manner and are encouraged to check the Medi-Cal website regularly for updates regarding this issue.

Replacement Medication for Family PACT Clients Impacted by the State of Emergency (August 20, 2020)

Pharmacy and clinic providers must dispense the full amount of the requested medication covered under the Family Planning, Access, Care and Treatment (Family PACT) Program immediately if the need to dispense is related to the client’s displacement or subjection to fires and extreme fire weather conditions or public safety power shutoff.

This includes drugs that may require a Treatment Authorization Request (TAR). The need for a TAR should not negatively affect the decision to dispense the full amount of the required medication immediately and the TAR can be submitted retroactively. Providers are instructed to incorporate the statement “Patient impacted by fires and extreme fire weather conditions or public safety power shutoff” within the Miscellaneous Information field on the TAR for those drugs or situations requiring a TAR. It is imperative that the impacted client receive the full amount of the necessary medication in a timely manner to facilitate compliance and to not cause a delay or break in therapy.

TARs for medications (new, refill or replacement), if required, will be automatically approved if the TAR indicates that the client is impacted by fire, or by power shutoffs, and the provider will be paid for the claim for the dispensed medications. The negative impact of the fire or power shutoff, alone, will meet the criteria of medical necessity.

Providers are encouraged to monitor the Medi-Cal website for future updates.

Notice Regarding State Nondiscrimination Requirements (Updated June 13, 2020)

Click this link for the full notice.

Additional Screening of Family PACT Provider Applicants in Certain Counties (December 2019)

Pursuant to Welfare and Institutions Code (W&I Code), Section 14132(aa)(2) and 24005(e), the Department of Health Care Services (DHCS) Office of Family Planning (OFP) has the authority to screen Family Planning, Access, Care and Treatment (Family PACT) Program provider applicants pursuant to requirements developed by DHCS to determine suitability for the Family PACT Program. Accordingly, OFP requires that any Family PACT provider applicant located in Los Angeles, Orange, Riverside or San Bernardino counties seeking enrollment in the Family PACT Program for the first time or submitting an application for a change in enrollment will be subject to certain screening requirements, with the exception of entities who are licensed as clinics under Health and Safety Code (H&S Code), Section 1204, clinics exempt from licensure under H&S Code, Section 1206, student health centers and those operated by government entities.

DHCS has assessed the risk of fraud, waste and abuse from a program integrity perspective posed by the specific geographic locations described above. DHCS has determined that newly enrolling Family PACT provider applicants or existing Family PACT providers submitting an application for a change in enrollment in Los Angeles, Orange, Riverside or San Bernardino counties should be deemed to pose a risk of fraud, waste and abuse to the Family PACT Program, with the exception of entities who are licensed as clinics under H&S Code, Section 1204, clinics exempt from licensure under H&S Code, Section 1206, student health centers and those operated by government entities. This designation is based upon criteria including, but not limited to, the following:

• DHCS continues to find significant program integrity issues with certain Family PACT providers in Los Angeles, Orange, Riverside and San Bernardino counties
• DHCS’ reviews and investigations of Family PACT providers have led to numerous disenrollments from the Family PACT Program, Medi-Cal suspensions and referrals to the California Department of Justice
• DHCS’ experience with claims data that identify fraudulent billing practices
• DHCS’ expertise in investigating and identifying Medi-Cal fraud across a broad spectrum of providers

Due to the potential risk of fraud, waste and abuse, the Family PACT provider applicants described above are subject to the following additional enrollment screening:

DHCS will conduct onsite visits prior to any application approval, including newly enrolling Family PACT provider applicants or existing Family PACT providers submitting an application for a change in enrollment, as described above.

Essure NewsFlash (December 2019)

This notice is to inform providers of the US Food and Drug Administration’s (FDA) communication on Essure Permanent Birth Control units that have not been implanted. On December 31, 2018, Bayer stopped selling and distributing the Essure device in the United States. Bayer informed their customers that all Essure units that have not been implanted should be returned to Bayer by the end of 2019.

For additional information, refer to the FDA website at https://www.fda.gov/medical-devices/essure-permanent-birth-control/fda-activities-essure

Breast and Cervical Cancer Treatment Program (BCCTP) “Directions to Apply for Medi-Cal” for All Applicants

BCCTP has a new “Directions to Apply for Medi-Cal” document for ALL BCCTP applicants. The English and Spanish versions, will eventually be automatically generated with the confirmation document that prints after the enrolling provider submits a BCCTP application. This covers ALL applicants regardless of whether or not they are approved for presumptive eligibility.  Click here for English directions to apply.  Click here for Spanish directions to apply.

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