Provider Enrollment

Upcoming 2023 Orientation dates:

February 9 (Virtual via Zoom)
April 13 (Sacramento, In-Person)
June 8 (Virtual via Zoom)
August 10 (Virtual via Zoom)
September 14 (Los Angeles, In-Person)
October 12 (Virtual via Zoom)
December 14 (Virtual via Zoom)

Provider Enrollment Process

The Provider Enrollment process begins with provider applicants completing the required Provider Orientation training prior to application submission. The Provider Orientation training consists of two parts:

Online training (Family PACT Overview)
In-Person Orientation

Register in LMS

Trainings must be completed by all staff who will be certifying eligibility and/or rendering family planning services prior to submitting a Family PACT application. Trainings are preassigned into “Learning Tracks” according to the role of the individual within the clinic.

Each Learning Track contains a list of trainings designed to provide a comprehensive overview of the Family PACT program as well as tailored modules specific to the Site Certifier, Clinician, or Administrative function. Upon acknowledgement of your role within the clinic, choose the learning track that is most appropriate based on the track description.

In Person Orientation

In the LMS, you will be prompted to register for this training after successful completion of the Family PACT Overview online training. Register for and attend an In-Person Training.

Please contact us at OFPprovidertrainings@dhcs.ca.gov or (916) 650-0414 with any questions.

Submit Application via:

PAVE Provider Portal:

All provider types (PTs) eligible to apply for Family PACT must complete the Family PACT Provider supplemental application using PAVE. The Provider Agreement DHCS 4469 and Practitioner Agreement DHCS 4470 must be uploaded prior to submission, as applicable.

Effective January 1, 2023, applications received via DocuSign, mail, or email will not be accepted.

To learn how to access and begin the Family PACT supplemental application through PAVE, choose the job aide for your provider type:

To learn how to complete and submit the Family PACT supplemental application through PAVE, choose the job aide for your provider type:

In addition, all providers and provider applicants are required to use the PAVE Provider Portal to make changes, recertify, and voluntarily disenroll from the Family PACT program.

Additional changes that require notification include: service address, NPI, TIN, legal or business name. These changes do not require a provider to attend a provider orientation to certify the site.

Providers are required to report any changes in practitioner personnel to DHCS OFP and PED on PAVE within 35 calendar days of the action taken and must also complete any required trainings outlined above.

Newly hired staff who fulfills the role of the Site Certifier and Clinician (non-Site Certifier) must complete the required Provider Trainings and Orientation prior to updating the Family PACT application.

Family PACT Provider Enrollment Checklist

This is a checklist designed to help site certifiers, clinicians, and clinic staff familiarize themselves with the Family PACT program requirements for enrollment and for Site Certifiers/Providers to successfully navigate the enrollment process to become a Family PACT Provider.

Provider Enrollment Instructions

Application Process

Solo providers, group providers or primary care clinics, who currently have a National Provider Identifier (NPI), are enrolled in good standing with Medi-Cal, and have the family planning skills, competency and knowledge to provide comprehensive family planning are eligible to apply for enrollment into the Family Planning, Access, Care, and Treatment (Family PACT) Program. Providers must be able to provide the full range of services covered in the Program. Providers that are interested in enrolling into the Family PACT Program must apply for enrollment by completing and submitting an application via the PAVE Portal. Please familiarize yourself with the requirements of the Family PACT Program and its provider enrollment requirements which can be found in the Family PACT Program’s Policies, Procedures and Billing Instructions Manual.

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

Each provider site must maintain legible copies of all initial and updated applications, as well as initial and updated practitioner agreements. and training records.

Physicians and Non-Physician Medical Practitioners (NMPs) employed by a Medi-Cal provider who are 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 Provider Agreement (DHCS 4469),
Complete a Family PACT Program Practitioner Participation Agreement (DHCS 4470)*, and
Complete the trainings identified on the Learning Management System.

*Please Note: The DHCS 4470 is not required to be completed by Primary Care Clinics, Affiliate Primary Care Clinics, RHCs, IHCs, and government providers.

Trainings are determined based on your role in the clinic. See below:

Site Certifiers

The Medical Director, Physician, Certified Nurse Practitioner or Certified Nurse Midwife who is responsible for overseeing the family planning services rendered at the site.

In-Person Orientation (pre-requisite: All online trainings)
Online Orientation (Optional)
Fraud, Waste, and Abuse
Documenting FPACT Services
U.S. Medical Eligibility Criteria (2016)
U.S. Selected Practice Recommendations (2016)
Back Office Training

Clinicians

Physicians and Non-Physician Medical Practitioners (NMPs) including Nurse Practitioners, Physician Assistants and Certified Nurse Midwives. This track is for practitioners who are NOT identified as the site certifier.

In-Person Orientation (Optional)
Online Orientation
Fraud, Waste, Abuse Training
Documenting Family PACT Services
U.S. Medical Eligibility Criteria (2016)
U.S. Selected Practice Recommendation (2016)
Back Office Training

Administrative

Required for Medical Assistants (MAs) and Front Office Staff such as Office/Clinic Managers, office assistants, or those who certify clients for enrollment, deliver client education and counseling and manage medical records on behalf of the Family PACT Program.

In-Person Orientation (Optional)
Online Orientation
Fraud, Waste, Abuse Training
Documenting Family PACT Services
Back Office Training
Front Office Training

Recertification

Family PACT-enrolled providers must re-certify every five (5) years or as required by DHCS. Family PACT enrolled providers elected 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.

Deactivation of Non-Participating Family PACT Providers

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 Welfare and Institutions Code 24005 (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 by a letter sent to the address on file.

Provider Voluntary Disenrollment Instructions

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

Providers are responsible to ensure unused HAP cards are returned to the Fiscal Intermediary (FI) at the time of disenrollment from Family PACT. Unused HAP cards must be packaged with a cover letter, including the provider number or NPI used to order the cards, and returned to UPS of a similar service to the FI at:

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

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.