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Form DHCS4469 Provider Agreement - Family Pact (Planning, Access, Care, and Treatment) Program - California
What Is Form DHCS4469?
This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the DHCS4469 Provider Agreement?
A: The DHCS4469 Provider Agreement is a contract between providers and the California Department of Health Care Services (DHCS) to participate in the Family Pact program.
Q: What is the Family Pact program?
A: The Family Pact program, also known as the Planning, Access, Care, and Treatment (PACT) program, provides family planning services to eligible low-income individuals in California.
Q: Who can participate in the Family Pact program?
A: Eligible low-income individuals in California, including men and women, can participate in the Family Pact program.
Q: What services does the Family Pact program cover?
A: The Family Pact program covers a wide range of family planning services, including contraceptives, reproductive health exams, counseling, and education.
Q: How can providers participate in the Family Pact program?
A: Providers can participate in the Family Pact program by completing and submitting the DHCS4469 Provider Agreement form to DHCS.
Q: Are there any requirements for providers to participate in the Family Pact program?
A: Yes, providers must meet certain requirements, including being a Medi-Cal provider or having a valid license or certification in their field of practice.
Q: How do providers get reimbursed for services provided through the Family Pact program?
A: Providers can submit claims for reimbursement to DHCS through the normal billing process, following the program's billing guidelines.
Q: Is there a cost to individuals participating in the Family Pact program?
A: No, eligible individuals do not have to pay for family planning services received through the Family Pact program.
Q: What is the goal of the Family Pact program?
A: The goal of the Family Pact program is to ensure access to comprehensive family planning services for low-income individuals in California.
Form Details:
- Released on April 1, 2023;
- The latest edition provided by the California Department of Health Care Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form DHCS4469 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.
Download Form DHCS4469 Provider Agreement - Family Pact (Planning, Access, Care, and Treatment) Program - California
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