Provider Enrollment

For detailed information about the eligibility criteria and requirements for provider enrollment for the Family Planning, Access, Care and Treatment (Family PACT) Program, please refer to the Provider Enrollment and Responsibilities section of the Family PACT Policies, Procedures and Billing Instructions Manual (PPBI).

Enrollment Process

The provider enrollment process for the Family PACT Program consists of the following three phases, to be completed in the order listed:

Learn about the Family PACT program and provider enrollment requirements

  • What is the Family PACT Program?
  • Family PACT Program Standards
  • Who is eligible to enroll?
  • How does enrollment work
  • Designate a Site Certifier

Complete Family PACT required trainings

  • Create an account in the Online Training Center Learning Management System (LMS)
  • Identify your learning track
  • Complete the required trainings for your learning track
  • If you are the designated Site certifier, attend the Provider Orientation

Complete and submit the Family PACT Supplemental Application through the Provider Application and Validation for Enrollment (PAVE) Portal

  • When Should You Submit a Family PACT Application?
  • How Do You Submit a Family PACT Application?
  • Updating Account Information
  • Additional Screening of Family PACT Provider Applicants
  • Recertification
  • Deactivation of Non-Participating Family PACT Providers
  • Voluntary Disenrollment Instructions

Throughout the process, we encourage you to use the self-checklist designed to help site certifiers, clinicians, and administrative staff familiarize themselves with the Family PACT Program requirements for enrollment and for site certifiers/clinicians/administrators to successfully navigate the enrollment process to become a Family PACT provider. You do not have to submit the checklist with your Family PACT application.

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Phase 1: Determine If You Are Eligible to Enroll as a Family PACT Provider

What is the Family PACT Program?

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

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.

Who is Eligible to Enroll?

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 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.

How Does Enrollment Work?

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.

Designate A Site Certifier

Each service location must designate one eligible representative, who works at the service location, to be the location’s site certifier. A Medical Director, physician, 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.

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Phase 2: Complete Family PACT Required Trainings

Create An Account in the Online Training Center Learning Management System (LMS)

Create an account in the Online Training Center Learning Management System (LMS).  This is where you will register for and complete the required online trainings for your learning track.

Trainings must be completed by all staff who will be enrolling or recertifying a clinic site into the Family PACT Program and/or rendering family planning services prior to submitting a Family PACT application.

Identify Your Learning Track

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 following clinic functions:

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

Clinician
Physicians and Non-Physician Medical Practitioners including Nurse Practitioners, Physician Assistants and Certified Nurse Midwives who are NOT identified as the site certifier.

Administrator
Medical Assistants 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.

Complete the Required Trainings for Your Learning Track
Attend the Provider Orientation (only applicable to site certifiers who completed the online trainings in the Site Certifier Track)

Medi-Cal enrolled providers, who will serve as the enrolling location’s site certifier, must first complete all the required online courses assigned to the site certifier track, and then must complete the legislatively mandated Provider Orientation per Welfare and Institutions Code § 24005, subd. (k). The Provider Orientation provides an overview on comprehensive family planning, program benefits and services, client eligibility, provider responsibilities and compliance. The Provider Orientation is a live session conducted over Zoom where providers will learn how to successfully implement the Family PACT Program and its requirements into their practice.

The Provider Orientation session is a requirement for all site certifiers and must be completed prior to submitting a Family PACT enrollment or recertification application. Only site certifiers may attend the Provider Orientation; all other clinic staff will not be admitted.

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

Phase 3: Complete the Family PACT Supplemental Application

When Should You Submit a Family PACT Application?

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
How Do You Submit a Family PACT 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

Unsupported provider types in PAVE

Federally Qualified Health Centers and Primary Care Clinics

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.
Provider and Practitioner Agreements

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:

*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.

Application Deficiencies

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.

Updating Account Information

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.

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.

Additional Screening of Family PACT Provider Applicants

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 screen requirements see the Provider Enrollment and Responsibilities section in the PPBI.

Recertification

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

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 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.

Voluntary Disenrollment Instructions

Providers may voluntarily terminate their participation in the Family PACT Program at any time by submitting a disenrollment 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