Quarterly News and Updates

September 2025

Table of Contents

• Clinical Updates
• Upcoming Events
• Family PACT Enrollment
• Family PACT Bulletins
• Medi-Cal Bulletins
• Contact US

CLIA-Waived Tests and Family PACT

What is a CLIA-waived test?

• The Clinical Lab Improvement Amendments (CLIA) is a law requiring any facility performing lab tests on human specimens to be appropriately certified.
• “CLIA-waived” tests, such as urine pregnancy tests, are determined by the FDA to have little risk for error. They can be offered in a laboratory with a CMS CLIA Certificate of Waiver (or equivalent).
• Often, point-of-care (POC) testing refers to CLIA-waived tests, but advances in technology have enabled more complex non-waived testing to be performed at the point of care, so “POC” testing is not an equivalent term to “CLIA-waived” testing.
• New CLIA-waived tests are announced in CMS MLN Matters publications; example: MM14025 - New Waived Tests (5/9/25). 

Which CLIA-waived tests does the Family PACT Program cover?

• CLIA-waived tests covered by Family PACT can be found by Current Procedural Terminology (CPT®) Code in the Family PACT Policies, Procedures and Billing Instructions Manual (PPBI)*.
• At the time of this publication, Family PACT coverage includes (but is not limited to) the following sexually transmitted infection (STI) CPT codes:

• 87491: Chlamydia trachomatis
• 87591: Neisseria gonorrhoeae
• 87808: Trichomonas vaginalis
• 87563: Mycoplasma genitalium
• 86780: Treponema pallidum (syphilis)
• 86703, 87806: HIV

Which CLIA-waived tests does Medi-Cal cover?

• Information on covered CLIA-waived tests and billing guidance can be found in the Medi-Cal Provider Manual, section: Pathology: Billing and Modifiers (path bil)*.

*Family PACT providers should refer to path bil for information on how to bill for CLIA-waived tests using the QW modifier. 

Subcutaneous Depot Medroxyprogesterone Acetate 104 mg/0.65 mL (DMPA-SQ)

Effective for dates of service on or after October 1, 2025, the initial dose of DMPA-SQ (SubQ Depo) has been added as a clinic benefit for Family PACT and Medi-Cal.

Previously, Family PACT and Medi-Cal covered DMPA-SQ for pharmacy dispensing only. This update will allow the initial dose of DMPA-SQ to be administered in clinic by the client for the purpose of client training and education for the self-administration of future doses and reimbursed as a clinic benefit (HCPCS code J3490).

• Providers may not bill an administration fee for this initial injection.
• Subsequent doses of DMPA-SQ are to be dispensed by a pharmacy and self-administered by the client at home.

The Family PACT and Medi-Cal Family Planning manuals have been updated accordingly:

• Family PACT

o  Benefits: Family Planning (ben fam) (page 16)

o  Benefits Grid (ben grid) (page 5, 53)

o  Clinic Formulary (clinic) (page 12)

o  Drugs: Onsite Dispensing Billing Instructions (drug) (page 2, 6)

o  Drugs: Onsite Dispensing Price Guide (drug onsite) (page 1)

• Medi-Cal

o  Family Planning (fam planning) (page 4, 12)

Please note that the coverage for intramuscular DMPA (medroxyprogesterone acetate 150 mg/mL, administered IM) remains unchanged.

Reproductive Health Hotline (ReproHH)

Comprehensive IUD and Contraceptive Implant Placement Training

October 15-17, 2025

1500 Capitol Ave, Sacramento, CA 95814

Join us October 15-17 for a FREE three-day training series where providers build skills and confidence in intrauterine device (IUD) and contraceptive implant services.

Choose from IUD & Implant Placement Training on October 15-16 (same training offered twice, with bonus hands-on skills lab) or an Implant-Only Placement Training on October 17.

Participants will earn Continuing Medical Education (CME) credits through expert clinical instruction and hands-on practice designed to expand access to long-acting reversible contraception (LARC) across California.

The training is eligible for up to 8 CME credits.

NOTE: Oct 15 and Oct 16 are identical sessions. Register for one date only. No walk-ins.

What Is the Family PACT Portal?

The Family Planning, Access, Care and Treatment (Family PACT) client enrollment and transaction services transitioned to the Family PACT Portal. This platform is housed in CalHEERS, which is where Medi-Cal and Covered California members apply and renew their coverage. The Family PACT Portal simplifies and streamlines the eligibility process for Family PACT clients. The Family PACT Portal consists of the Client Portal and the Provider Portal.

• The Client Portal allows users to create accounts, apply for Family PACT, and manage their enrollment status online.

• The Provider Portal enables Family PACT providers to efficiently enroll and recertify clients.

To access the new portal, providers are required to update their site certifier contact information in the Provider Application and Validation for Enrollment (PAVE) Portal to receive their login credentials.

Providers who do not have a current site certifier in PAVE are instructed to immediately email the site certifier's first and last name and email address to Providerservices@dhcs.ca.gov or call (916) 650-0414.

As of February 3, 2025, Health Access Programs (HAP) cards are no longer being issued by the Fiscal Intermediary (FI).

HAP cards are now digitized and can be accessed and printed directly from the user’s Family PACT account via the Family PACT Portal. The HAP Identification Number can be printed or shown electronically on a mobile device when visiting a provider. Providers can print the card for the client, or the client may print it themselves.

Returning Unused HAP Cards

Providers are responsible for returning any unused numbered HAP cards to the FI as soon as possible.

To return unused HAP cards, package the unused numbered HAP cards with a cover letter that includes your provider number or NPI used to order the cards. Mail the package via UPS or a similar service to the following address:

California MMIS Fiscal Intermediary

Attn: Print and Distribution Center

830 Stillwater Road

West Sacramento, CA  95605 

Site Certifier Policy Update

Beginning late October 2025, Senate Bill 1131 will be implemented by updating policy to allow one site certifier to oversee up to 10 service locations for designated clinic types specified in the Provider Enrollment and Responsibilities section of the Policies, Procedures, and Billing Instructions (PPBI) Manual..

Providers designating a site certifier to oversee multiple locations must submit a signed updated Family PACT Provider Agreements (DHCS 4469) and the new Site Certifier for Multiple Service Locations Declaration Form, which DHCS will review for approval. Both documents are not yet available but will be released soon for provider use.

The Family PACT Portal will be updated to reflect these changes. These updates serve as user functionality enhancements, focusing on expanding site certifier and provider staff site location limitations while adding more flexibility when editing or changing accounts.