Category: Uncategorized

An Erroneous Payment Correction (EPC) will be implemented to reprocess denied claims with dates of service on or after the effective date of this billing policy, that were appropriately submitted based on the guidance published in this article, but erroneously denied because Medi-Cal had not yet implemented the system changes to support appropriate adjudication. Providers may also elect to use this updated billing policy to correct and resubmit previously denied claims as described in the CIF Submission and Timeliness Instructions section of the Provider Manual.

Please refer to the March Family PACT Bulletin for more information.

The Department of Health Care Services (DHCS) will perform a system update to the Family PACT Portal beginning at 10:00 p.m. on Friday, May 2, 2025, through 8:00 p.m. on Sunday, May 4, 2025. During this time, the Family PACT Portal will be unavailable to clients, providers, and DHCS staff.

Providers affected by this outage should continue enrolling and reaffirming clients using the Client Eligibility Certification (CEC) paper form and provide services as usual. To ensure uninterrupted service during the outage, providers will need to initiate downtime procedures.

Downtime Procedures for Family PACT Providers:

New Clients:

• Complete the CEC Form to determine eligibility.
• If eligible, proceed with the visit under the Family PACT program.
• Submit the client’s enrollment in the Family PACT Portal as soon as possible once access is restored (e.g., Monday, May 5, 2025).

Returning Clients:

• Reaffirm eligibility using a new CEC Form.
• Proceed with the scheduled visit.

For clients seen during the downtime period, providers must contact the Office of Family Planning (OFP) to back-date enrollment to date of service.

For any questions or assistance, please contact providerservices@dhcs.ca.gov or via phone at 916-650-0414.

What You Need to Know:

1. HAP Cards No Longer Issued:
   • Effective January 13, 2025, HAP cards will no longer be provided by the FI.
2. HAP Identification:
   • HAP cards are now digitized and can be accessed and printed directly from the user’s Family PACT account via the Family PACT portal. The number can be printed or shown electronically on a mobile device when visiting a provider. Providers can print the card for the client, or the client may print it themselves.
3. Returning Unused HAP Cards:
   • Providers are responsible for returning any unused numbered HAP cards to the Fiscal Intermediary (FI) as soon as possible.
4. To return unused HAP cards:
   • Package the unused numbered HAP cards with a cover letter that includes your provider number or National Provider Identifier (NPI) used to order the cards.
   • Mail the package via UPS or a similar service to the following address:

California MMIS Fiscal Intermediary
Attn: Print and Distribution Center
830 Stillwater Road
West Sacramento, CA 95605

1. Accessing the New CalHEERS Family PACT Portal:
   • To access the Family PACT portal, providers must ensure the most current site certifier contact information is updated in PAVE to receive login credentials.
   • If a site certifier is not in PAVE, send the site certifier information (practitioner NPI, first and last name, email address) to providerservices@dhcs.ca.gov
   • Note: Even if the site certifier information is sent via email, you are still required to update PAVE with the most current site certifier information.

Moving Forward:

• On February 3, 2025, all Family PACT client enrollment activities, including changes and deactivations, will be completed exclusively through the Family PACT portal.
• No further HAP cards will be issued.
• Providers have access to comprehensive training and job aids through the Family PACT Online Training Center Learning Management System.
• Updates will be posted on the Family PACT website.

For any questions or assistance, please contact providerservices@dhcs.ca.gov.

The Family PACT client eligibility and enrollment transaction services will transition from the Health Access Programs Client Eligibility System to the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS), Family PACT portal in early 2025. Updates regarding the implementation of CalHEERS Family PACT portal will be published in future bulletins.

Required system upgrades to the California Medicaid Management Information System (CA-MMIS) was originally scheduled to take place on August 18, 2024. It will now take place on August 25, 2024. The upgrade will go into an extended maintenance period, which begins at midnight on Sunday, August 25, 2024, and may continue through 6:00 p.m. Sunday, August 25, 2024.

The following Medi-Cal Providers website applications may experience intermittent issues during this window.

• Single and Multiple Subscriber Eligibility
• Share of Cost
• Medical Reservation Services (Medi-Services)
• Lab Service Reservation
• Family Planning, Access, Care, and Treatment (Family PACT)
• Electronic Treatment Authorization Request (eTAR)

Additionally, the following transactions also may experience intermittent issues.

• Automated Eligibility Verification System (AEVS) transactions
• Point of Service (POS) network eligibility transactions from Core Connectivity, Leased Line vendors and Case Management Information and Payrolling System (CMIPS)

Please return to this System Status page for future updates.

If the above link does not take you to the System Status page, then simply copy and paste the following link into your browser.

https://mcweb.apps.prd.cammis.medi-cal.ca.gov/system-status

Effective July 16, 2024, the Department of Health Care Services has updated the Family Planning, Access, Care, and Treatment (Family PACT) Program’s provider enrollment and responsibilities policy with respect to Site Certifiers role and responsibilities and the Provider Orientation and required trainings for Site Certifiers and practitioners.

Additional information about Provider Enrollment and Responsibilities is available on the Family PACT Provider Enrollment webpage and in the Family PACT Policies, Procedures and Billing Instructions (PPBI) Manual, Provider Enrollment and Responsibilities section.

Effective April 15, 2024, DHCS has expanded the clinicians eligible to be a Family Planning, Access, Care, and Treatment (Family PACT) Program site certifier to include Physician Assistants and has made updates to the required provider training requirements.

Additional information about Provider Enrollment and Responsibilities is available on the Family PACT Provider Enrollment webpage and in the Family PACT Policies, Procedures and Billing Instructions (PPBI) Manual, Provider Enrollment and Responsibilities section. 

Effective for dates of service on or after April 1, 2024, providers are to use the following income guidelines when determining recipient eligibility for the Family PACT Program.

Federal Income Guidelines

200 Percent of Poverty by Family Size

Effective April 1, 2024

Number of Persons in Family/Household	Monthly Income	Annual Income
1	$2,510	$30,120
2	$3,407	$40,880
3	$4,303	$51,640
4	$5,200	$62,400
5	$6,097	$73,160
6	$6,993	$83,920
7	$7,890	$94,680
8	$8,787	$105,440
For each additional member, add:	$897	$10,760

The Department of Health Care Services (DHCS) would like to inform pharmacy providers and prescribers about the addition of over-the-counter (OTC) oral contraceptive, Opill® (norgestrel 0.075 mg). This update will be reflected in the April 1, 2024, publication of the Medi-Cal Rx Family PACT Pharmacy Formulary.

Please refer to the Medi-Cal Pharmacy Bulletin for additional information.

Medi-Cal is changing its rules so more people can get covered. Starting January 1, 2024, more adults will be eligible for full Medi-Cal benefits. Immigration status doesn’t matter. Even if you’ve been denied full Medi-Cal recently, you could be eligible now. Learn more about the rule changes and apply today at GetMedi-CalCoverage.dhcs.ca.gov!