Provider Enrollment

Family PACT is a comprehensive family planning services program.

It is comprehensive because the Program covers all FDA-approved contraceptive methods and family planning-related services, together with client-centered health education and counseling. The overall goal of the Family PACT Program is to ensure that low-income women and men have access to health information, counseling, and family planning services to reduce the likelihood of unintended pregnancy and to maintain optimal reproductive health. The intent of the Program is to provide eligible California women and men access to comprehensive family planning services in order to:

• Establish the timing, number and spacing of their children
• Maintain optimal reproductive health

The Family PACT Program Standards defines the scope, type, and quality of the Program, and the terms and conditions under which services will be reimbursed. Adherence to these standards is required for provider locations and clinicians enrolled as Family PACT providers.

DHCS is committed to ensuring that all eligible clients and their families enroll in health insurance plans as required by the Patient Protection and Affordable Care Act (ACA). Many clients served by the Family PACT Program will be eligible for health insurance coverage through Medi-Cal program expansion or subsidized health insurance through Covered California (www.coveredca.com).

Family PACT is considered the payer of last resort. That is, the provider generally must bill the client’s Other Health Coverage (OHC) and any other source of reimbursement rather than enrolling the client in Family PACT.  Clients who are not eligible for these programs and who remain in the Family PACT Program should be routinely referred to community health centers to receive primary services beyond the scope of the Family PACT Program.

The Family PACT Program Standards defines the scope, type, and quality of the Program, and the terms and conditions under which services will be reimbursed. Adherence to these standards is required for provider locations and clinicians enrolled as Family PACT providers.

Solo providers, group providers, Primary Care Clinics, Affiliate Primary Care Clinics, Federally Qualified Health Centers, Tribal FQHCs, community clinics, intermittent clinics, mobile clinics, Rural Health Centers, IHS-MOA 638 clinics, certain specialty clinics, and outpatient hospitals are eligible to apply for enrollment in the Family PACT Program if they currently have a National Provider Identifier (NPI) and are enrolled in Medi-Cal in good standing.

Only licensed medical personnel with family planning skills, competency, and knowledge, may provide the full range of services covered by the Family PACT program. Medi-Cal enrolled providers, as determined by the Department of Health Care Services (DHCS), shall be eligible to provide family planning services under the program when the services are within their scope of practice and licensure, either directly or by referral, consistent with the standards of care (see more in the Program Standards section of the PPBI) issued by the Department. Family PACT providers are required to offer and provide Long-Acting Reversible Contraception (intrauterine devices and contraceptive implant) onsite. As such, each site enrolling into the Family PACT Program must identify, at a minimum, one practitioner trained to provide long-acting reversible contraception (LARC) services onsite.

A Family PACT application submitted by a provider in which the service location and/or the participating providers identified on the application for enrollment are not enrolled in Medi-Cal or not in good standing with Medi-Cal shall be denied.

A provider’s enrollment is location specific and only the service location is enrolled in Family PACT. Individual practitioners (MD, PA, CNP, CNM, etc.) are not enrolled in Family PACT and are instead added under a location’s enrollment.

A (physical) service location is certified for enrollment under one provider’s NPI, and no other organizational NPI may enroll in Family PACT at the same service location. All Family PACT services shall be rendered by, or at, an enrolled service location(s) only. A telehealth only facility is not eligible to enroll in the Family PACT Program.

Any enrollment forms received by a third party (examples: consultants, attorneys, or enrollment brokers) will not be accepted. Additionally, third parties (examples: consultants, attorneys, or enrollment brokers) must not be the contact person listed on the application.

Each service location must designate one eligible representative, who works at the service location, to be the location’s site certifier (see more in the Provider Enrollment and Responsibilities section of the PPBI). A medical director, physician, physician assistant (PA), certified nurse practitioner (CNP), or certified nurse midwife (CNM) who is enrolled in Medi-Cal is eligible to certify the site. The designated site certifier must be identified on the application for enrollment and is responsible for overseeing the family planning services rendered at the identified service location to be enrolled. Site certifiers can only certify one location.

They are responsible for ensuring all practitioners and personnel providing services on behalf of the Family PACT Program, complete and track trainings required by OFP.

Eligible providers should submit an application:

• For initial enrollment into the Program
• For recertification as requested by OFP
• To report any change in information previously submitted on an application

All eligible providers may apply for Family PACT using the Provider Application and Validation for Enrollment (PAVE) Portal. All required Family PACT trainings must be completed prior to applying. No paper applications are accepted.

For assistance with starting and/or completing your application in PAVE, please see the following job aides:

Supported provider types in PAVE

• Job aide to begin application
• Job aide to complete & submit application

Unsupported provider types in PAVE

• Job aide to begin application
• Job aide to complete & submit application

Federally Qualified Health Centers and Primary Care Clinics

• Job aide to begin application
• Job aide to complete & submit application

To determine if you are a supported provider type, please see the list of the provider types supported in PAVE.

Providers who insert intrauterine devices (IUDs) or contraceptive implants must be indicated on the application for enrollment. Each practitioner identified on the application for enrollment as trained to provide LARC services must:

• Be identified as having a Women’s Health Specialty, or
• Upload proof of training or a signed affidavit.

All providers must complete and upload the Family PACT Provider Agreement DHCS 4469 and Practitioner Agreement*, as applicable.

Physicians and Non-Physician Medical Practitioners employed by a Medi-Cal provider who is applying to enroll in the Family PACT Program and who will be delivering Family PACT services must:

• Be identified on the Provider Application
• Complete a Family PACT Program Practitioner Participation Agreement (DHCS 4470)*, and
• Complete the trainings identified in the Online Training Center Learning Management System.

*Please Note: The DHCS 4470 is not required to be completed by Affiliated Primary Care Clinics (APCCs), nonprofit community clinics or Primary Care Clinics (PCCs), or Indian Health Services, Memorandum of Agreement (IHS-MOA) 638, Clinics.

The following supporting documentation is required for participation in the Family PACT Program and may be requested during the application process:

• All clinic policies and procedures for Family PACT client eligibility and enrollment (for example: policies and procedures and/or staff training plan for enrolling clients, record retention of CEC forms, security plan for Health Access Programs (HAP) cards, client appointment process, etc.).
• All clinic policies and procedures for referrals and follow-ups for referring clients for services covered by Family PACT, but not offered by the provider (for example: clinician visit/back office documentation procedures, documentation procedures for the education and counseling provided, and the patient outcome/treatment plan, etc.).
• Clinic organizational chart (for example: staff list and roles for each, etc.).
• Any additional documentation requested by DHCS.

For more information on additional documentation refer to the Provider Enrollment and Responsibilities section of the PPBI manual.

Applicants are allowed 60 calendar days from the notification date to resubmit a corrected application when the application is returned deficient. If a Family PACT provider applicant fails to resubmit the corrected application to PAVE or fails to remediate the deficiencies within 60 calendar days, the application will be denied. Applicants denied for failure to resubmit or remediate deficiencies in a timely manner may reapply at any time.

All providers and provider applicants are required to use the Provider Applicants and Validation Enrollment (PAVE) Provider Portal to make changes, recertify, and voluntarily disenroll from the Family PACT Program.

Providers are required to report any changes in practitioner personnel to California Department of Health Care Services (DHCS), Office of Family Planning (OFP) and Provider Enrollment Division (PED) via PAVE within 35 calendar days of the action taken and must also complete any required trainings.

Newly hired staff who fulfill the role of the site certifier and clinician (non-site certifier) must complete the required provider trainings and Provider Orientation prior to updating the Family PACT application.

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

For more information on additional screening requirements see the Provider Enrollment and Responsibilities section of the PPBI manual.

Family PACT enrolled providers will be directed to re-certify their Family PACT program enrollment every five (5) years. Providers required to re-certify will be notified via PAVE and must complete the steps outlined in the notification letter received for continued participation in the Family PACT Program.

For more information on additional documentation refer to the Provider Enrollment and Responsibilities section of the PPBI manual.

DHCS will deactivate providers from the Family PACT Program who have not submitted a claim for reimbursement from the Program for one year.

Pursuant to California Welfare and Institutions Code section 24005, subdivision (i)(3), the department shall deactivate, immediately and without prior notice […] when a provider has not submitted a claim for reimbursement from the program for one year.

Deactivation from the Family PACT Program does not affect Medi-Cal enrollment. Deactivated providers will be notified via a letter sent to the address on file.

Providers may voluntarily terminate their participation in the Family PACT Program at any time by submitting a Withdraw application via the PAVE portal.

Providers are responsible for ensuring all unused Health Access Programs (HAP) cards are returned to DHCS’ Fiscal Intermediary (FI) at the time of disenrollment from Family PACT. Unused HAP cards must be sent with a cover letter that includes the provider number or NPI used to order the cards, via United Postal Service or a similar mailing service to the FI at:

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

For step-by-step instructions see Withdrawing an Application in PAVE.