Family PACT


Provider Enrollment

 

Solo providers, group providers or primary care clinics who currently have a National Provider Identifier (NPI), are enrolled, and in good standing with Medi-Cal, and have the ability to provide comprehensive family planning and reproductive health services through skills, competency and knowledge, and provide the full range of services covered in the program, are eligible to apply for enrollment into the Family Planning, Access, Care, and Treatment (Family PACT) program. Providers that are interested in enrolling into the Family PACT program must apply for enrollment by completing and submitting an application packet.


Submit an Application
- Effective September 1, 2017, the current DHCS 4468 application (4/2017) must be used when submitting an application to the Family PACT program. Any packet submitted with an out dated application will be returned. Please complete a Family PACT provider application packet and return to:

Email: ProviderServices@dhcs.ca.gov

*Please ensure you are using a secure browser/email when submitting confidential information!

Mail: Department of Health Care Services

Office of Family Planning

P.O. Box 997413 MS 8400 

Sacramento, California, 95899-7413

 

Complete the Provider Orientation.
New Family PACT providers and/or new provider locations will be provisionally certified for enrollment in the Family PACT Program after the provider is enrolled in Medi-Cal and the Family PACT program, until an eligible representative attends a legislatively mandated Provider Orientation as determined by DHCS. A provider must attend an orientation to certify the site within six (6) months of the date of the initial Family PACT enrollment for the provisional certification to be lifted.

A provider’s service location is required to be certified for enrollment in the Family PACT Program. Each service location must identify one provider to be the site certifier. The medical director, physician, nurse practitioner, or certified nurse midwife, who is responsible for overseeing the family planning services rendered at the enrolled location is eligible to certify the site. All Family PACT services shall be rendered at the enrolled service location(s) only.

The provider identified to certify the site must complete the legislatively mandated, two-part, provider orientation, within six (6) months of the date of initial Family PACT enrollment for the provisional certification to be lifted. If a provider does not complete both parts of the orientation within six (6) months of the date of initial Family PACT enrollment, that provider and/or provider location will be disenrolled from the Family PACT program. For more information on the two-part provider orientation, please click here.     

 

Please contact the Office of Family Planning by phone (916) 650-0414 or email us at ProviderServices@dhcs.ca.gov if you have any questions regarding the Provider Enrollment process.  

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