Office of the Agency Director Programs

Health Program of Alameda County (HealthPAC)

HealthPAC Contract Documents and Attachments - For Providers

• (A-1) HealthPAC Plan  (PDF - 430 kb) *
• Appendix A - DOFR  (PDF - 425 kb) *
• Appendix B - HPAC FPL Schedule  (PDF - 85 kb) *
• Appendix C - Guidelines for Determining Family Size  (PDF - 382 kb) *
• Appendix D - Income Tax Forms  (PDF - 310 kb) *
• Appendix E - HealthPAC Verification Documents  (PDF - 404 kb) *
• Appendix F - Statement of Income and Residency  (PDF - 354 kb) *
• Appendix G - HPAC Co-Pay Schedule  (PDF - 134 kb) *
• Appendix H - (A5) Quality Measurement and Improvement Plan  (PDF - 124 kb) *
• A-2 - Interpretations and Procedures  (PDF - 461 kb) *
• A-4 (Map) - Provider Network  (PDF - 577 kb) *
• A-6 - NET Transportation Policies and Procedures  (PDF - 470 kb) *
• HealthPAC PLAN:Eligibility, Applications, Enrollment, and Services (Effective: July 1, 2018)  (PDF - 255kb) *
• HealthPAC Formulary - By Brand Name  (PDF - 459kb)
• HealthPAC Formulary - By Class  (PDF - 457kb)
• HealthPAC Formulary - By Generic Name  (PDF - 445kb)

Results Based Accountability (RBA)

• Tutorial on RBA Scorecard (Oct 2016)
• RBA Training for Contractors