Provider Enrollment

Upcoming 2022 (Virtual) In-Person Orientation dates:

October 13
December 8

Register in the Learning Management System (LMS).

Provider Enrollment Process

Register in LMS

Register in the Learning Management System (LMS). This is where you will complete the required online trainings and learn the dates of the required in-person training.

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

Online Orientation

Complete the online Provider Orientation. After successful completion, you will be prompted to register for the in-person training.

In Person Orientation

Register for and attend an In-person Training. You will be prompted to register for this training after successful completion of the Online Orientation.

Submit Application via one of the following options:

Option 1: DocuSign
Complete the Family PACT Provider Application form DHCS 4468 and securely submit it via DocuSign. The additional required application forms will be provided to provider applicants via DocuSign upon approval of the DHCS 4468 form.

Option 2: Email
Complete the Family PACT Provider Application form DHCS 4468 and securely submit it via secure email to providerservices@dhcs.ca.gov . This is the first form in the application process. You will receive the others upon approval of the DHCS 4468 form.

Option 3: Mail
Complete the Family PACT Provider Application form DHCS 4468 and submit it via mail to:
Department of Health Care Services
Office of Family Planning
Family PACT Provider Enrollment
P.O. Box 997413, MS 8400
Sacramento, CA 95899-7413
This is the first form in the application process. You will receive the others upon approval of the DHCS 4468 form.

Option 4: PAVE Provider Portal
Complete the Family PACT Provider supplemental form using your PAVE account. The Provider Agreement DHCS 4469 and Practitioner Agreement DHCS 4470 must be uploaded prior to submission, as applicable.

Please note: Effective January 1, 2023, provider applicants will be required to use the PAVE Provider Portal to apply for enrollment into the Family PACT program.

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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 packet. 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.

The application packet shall be completed by the provider applicant only. Effective August 15, 2022, 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.

The current Family PACT application must be used when submitting an application to the Family PACT Program. Any packet submitted with an outdated application will be returned.

Please complete a Family PACT provider application packet and submit via one of the following options:

DocuSign:
DocuSign link

Email: 
ProviderServices@dhcs.ca.gov

Mail:
Department of Health Care Services
Office of Family Planning
P.O. Box 997413, MS 8400
Sacramento, California 95899-7413

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

Physicians and Non-Physician Medical Practitioners (NMPs) 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 (DHCS 4468), complete a Family PACT Program Provider Agreement (DHCS 4469)*, complete a Family PACT Program Practitioner Participation Agreement (DHCS 4470)*, and are required to complete the trainings identified on the Learning Management System.

*The DHCS 4469 and DHCS 4470 will be provided to applicants upon approval of the DHCS 4468 form.
            Please Note: The DHCS 4470 is not required to be completed by Primary Care Clinics, Affiliate Primary Care Clinics, FQHCs, RHCs, IHCs, and government providers.

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.

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

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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

 

All OFP required trainings can be found on the Learning Management System.

Remember, providers are required to report any changes in practitioner personnel to DHCS OFP and PED within 35 days of the action taken and must also complete any required trainings outlined above.

When submitting changes to a Medi-Cal record (service address, NPI, TIN, legal or business name) providers are required to indicate these changes by completing an application packet to Family PACT Provider Enrollment. These changes do not require a provider to attend a provider orientation to certify the site.

Newly hired staff who fulfills the role of the Site Certifier and Clinician (non-Site Certifier) have 60 days from the date of hire to complete the required Provider Orientation and Trainings.

Please hold all training records onsite.

Health Access Program (HAP) Card Distribution

The Family PACT Program is discontinuing policy on annual distribution of HAP cards with annual limits.  All HAP card order requests will be forwarded to the Office of Family Planning for review.  All requests for additional HAP cards and the number of additional cards approved will be reviewed on a case-by-case basis. Initial HAP card orders for all new providers will remain at 200 sequential and revised to 50 blank HAP cards. The Telephone Service Center shall continue to process approved HAP card distributions.

 

Recertification

Family PACT-enrolled providers must re-certify every three (3) years. Family PACT enrolled providers elected to re-certify will be notified by mail and must complete the steps outlined in Provider Enrollment for continued participation in the Family PACT Program.

Deactivation of Non-Participating Family PACT Providers

Effective January 1, 2019, the Department of Health Care Services will begin the process to 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.

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.