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. Effective for dates of service on or after February 1, 2018, the Family PACT Program’s provider enrollment requirements and policy have been updated. We encourage providers to review the Provider Enrollment policy in its entirety.
Effective March 1, 2018, the current DHCS 4468 application (2/2018) 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 Any packet submitted with an outdated application will be returned.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 return to:
Department of Health Care Services
Office of Family Planning
P.O. Box 997413 MS 8400
Sacramento, California, 95899-7413
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 (4469)*, complete a Family PACT Program Practitioner Participation Agreement (DHCS 4470)*, and are required to complete the trainings identified on the Learning Management System (LMS). Please visit the LMS at www.ofpregistration.org for more information.
*The DHCS 4469 and DHCS 4470 will be provided to applicants upon approval of the DHCS 4468 form.
Provisional Enrollment Period
New Family PACT service sites are provisionally certified for enrollment in Family PACT until an eligible representative completes the legislatively mandated Provider Orientation per Welfare and Institutions Code (W&I Code), Section (§) 24005(k). The Provider Orientation must be completed within six (6) months of the date of initial Family PACT enrollment for the provisional certification to be lifted. Failure to complete the orientation within six (6) months will result in disenrollment. Please visit our Learning Management System (LMS) at www.ofpregistration.org for a complete list of required trainings and training locations.
|1.||Submit Family PACT application via secure email|
|2.||Register in LMS|
|3.||Complete the Provider Orientation Modules|
|4.||Register/attend an In Person Orientation|
|5.||Complete the Provisional Enrollment Period|
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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