Family PACT Update

April 2021 | Bulletin 163


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1. Medi-Cal Coverage Under the COVID-19 Public Health Emergency

Under the continuous coverage requirements in the federal Families First Coronavirus Response Act (FFCRA), all Medi-Cal beneficiaries are maintained in their current aid codes until end of the coronavirus disease 2019 (COVID-19) public health emergency (PHE). As a reminder, individuals in pregnancy-related aid codes continue to remain eligible for non-pregnancy services, as appropriate, under current COVID-19 PHE protections. Providers are advised to continue submitting claims with applicable diagnosis codes.

Questions concerning eligibility under pregnancy-related aid codes during PHE should be sent to pregnancy@dhcs.ca.gov.

 

2. 2021 Income Eligibility Guidelines for Family PACT Program

Effective for dates of service on or after April 1, 2021, Family Planning Access, Care and Treatment (Family PACT) Program providers are to use the following income eligibility guidelines when determining client eligibility for Family PACT services. Providers should disregard all previous Family PACT income eligibility guidelines charts.

Federal Income Eligibility Guidelines
200 Percent of Poverty by Family Size
Effective April 1, 2021
Number of persons in family Monthly Income
(in dollars)
Annual Income
(in dollars)
1 2,147 25,760
2 2,903 34,840
3 3,660 43,920
4 4,417 53,00
5 5,173 62,080
6 5,930 71,160
7 6,687 80,240
8 7,443 89,320
For each additional person, add: 757 9,080

 

Provider Manual(s) Page(s) Updated
Family PACT client elig (2, 8, 9)
 

3. Updates to Billing Instructions for Contraceptive Vaginal Rings

Effective for dates of service on or after November 1, 2020, segesterone acetate and ethinyl estradiol vaginal system (Annovera®) is added as a benefit under Family Planning, Access, Care and Treatment (Family PACT) and Medi-Cal programs for clinic dispensing, and for Family PACT pharmacy dispensing.

For clinic dispensing, HCPCS code J7303 (contraceptive supply, hormone containing vaginal ring, each) must be billed with modifier U1 for etonogestrel and ethinyl estradiol (NuvaRing®) or U2 for segesterone acetate and ethinyl estradiol vaginal system (Annovera).

HCPCS code J7303U1 is restricted to a dispensing quantity of up to 13 rings, per client, with a maximum of two dispensings in a 12-month period. HCPCS code J7303U2 is restricted to one ring per dispensing, per client, with a maximum of two dispensings in a 12-month period. For both codes, a Treatment Authorization Request (TAR) is required for a third dispensing of the same product requested within a 12-month period.

Pharmacy dispensing of segesterone acetate and ethinyl estradiol vaginal system (Annovera) has the same restrictions as noted for J7303U2.

Provider Manual(s) Page(s) Updated
AIDS Waiver Program
Audiology and Hearing Aids
Chronic Dialysis Clinics
Durable Medical Equipment
Home Health Agencies/Home and Community-Based Services
Local Educational Agency
Medical Transportation
Orthotics and Prosthetics
Therapies
Vision Care
modif app (22, 23)
Clinics and Hospitals
General Medicine
Obstetrics
fam planning (5, 9); non ph (12, 24); modif app (22, 23)
Family PACT ben fam (12); ben grid (3, 45); clinic (20); drug (3, 6, 7); pharmacy (14)
Rehabilitation Clinics non ph (12, 24); modif app (22, 23)
 

4. Health Access Programs Client Enrollment System Updated

Effective May 3, 2021, the Health Access Programs (HAP) client enrollment system for the Family Planning, Access, Care and Treatment (Family PACT) Program has been updated. As a result, the Family PACT Client Eligibility Certification (CEC) form (DHCS 4461) and Retroactive Eligibility Certification (REC) form (DHCS 4001) have also been updated. Previous versions of the Family PACT eligibility forms should not be used on or after May 3, 2021.

Links to the forms can be found on the Medi-Cal Provider Forms web page and also at familypact.org.

The HAP client enrollment system has added the following data elements:

  • Address, Apartment, City, State and Address Type

  • Marital Status

  • Race/Ethnicity Codes Expanded

  • Updated Language Codes

  • Contact information

Family PACT will also begin to collect sexual orientation and gender identity (SOGI) data pursuant to Assembly Bill (AB) 959: Lesbian, Gay, Bisexual, and Transgender Disparities Reduction Act (Chiu, 2015). AB 959 requires DHCS to collect voluntary self-identification information pertaining to SOGI in the regular course of collecting other types of demographic data.

The HAP client enrollment system has removed the following data elements:

  • Number of Live Births

  • Place of Birth

  • State of Birth Codes

  • Country of Birth Codes

  • First Name, Middle Name and Last Name at Birth

  • Mother’s First Name

  • Current Name Same as Name at Birth
Provider Manual(s) Page(s) Updated
Family PACT client elig (6–9, 13); hap cards (6)
 

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6. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:



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