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Helena Ray, a member of the Harbrace Health Plan, suffers from migraine headaches. To treat

Ms. Ray’s condition, her physician has prescribed Upzil, a medication that has Food and Drug

Administration (FDA) approval only for the treatment of depression. Upzil has not been tested for

safety or effectiveness in the treatment of migraine headache. Although Harbrace’s medical policy

for migraine headache does not include coverage of Upzil, Harbrace has agreed to provide extracontractual

coverage of Upzil for Ms. Ray.

In this situation, the prescribing of Upzil for Ms. Ray’s headaches is an example of 

Health plans that offer healthcare programs for Medicare beneficiaries have a strong financial incentive for identifying high-risk seniors as early as possible. The identification of high-risk seniors is typically accomplished through the use of 

One true statement about state regulation of case management activities is that the majority of states  

The paragraph below contains two pairs of terms in parentheses. Determine which term in each

pair correctly completes the paragraph. Then select the answer choice containing the two terms

that you have chosen.

Health plans use both internal and external standards to assess the quality of the services that

they provide. (Internal / External) standards are based on information such as published industrywide

averages or best practices of recognized industry leaders. Health plans primarily rely on

(internal / external) standards to evaluate healthcare services. 

Comorbidity can have a significant impact on the effective implementation of disease management programs. Comorbidity can correctly be defined as the