The PEP program is a plan in which a physician provides a minimum package of basic services for a set monthly fee.
Services include preventive health exams, immunizations, comprehensive primary care services, limited laboratory services, EKGs, hospital care including emergency room care, some minor office services, and family planning services.
Services outside of the basic package are reimbursed according to the Medicaid fee schedule.
Recipient enrollment is voluntary and is available to current recipients except Medicare eligible recipients, pregnant women in the Optional Coverage for Women and Infants category, nursing home residents, and recipients in hospice or other waiver services.
The physician also provides or authorizes most primary care services; authorizes necessary specialty and inpatient services; provides or establishes a mechanism for around-the-clock coverage for services, maintains unified medical record documentation and provides patient education.
