For this question, if answer choices (A) through (C) are all correct, select answer choice (D). Otherwise, select the one correct answer choice. The QAPI (Quality Assessment Performance Improvement Program) is a Centers for Medicaid and Medicare Services (CMS) initiative designed to strengthen health plans’ efforts to protect and improve the health and satisfaction of Medicare beneficiaries. QAPI quality assessment standards apply to

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 

Examples of alternative healthcare practitioners are chiropractors, naturopaths, and acupuncturists. The only well-established credentialing standards for alternative healthcare practitioners are those available from NCQ A. These NCQA credentialing standards apply to 

Demetrius Farrell, age 82, is suffering from a terminal illness and has consulted his health plan

about the care options available to him. In order to avoid unwanted, futile interventions, Mr. Farrell

signed an advance directive that indicates the types of end-of-life medical treatment he wants to

receive. His family is to use this document as a guide should Mr. Farrell become incapacitated.

For this question, if answer choices (A) through (C) are all correct, select answer choice (D).

Otherwise, select the one correct answer choice.

Decisions regarding Mr. Farrell’s end-of-life care are legally the right and responsibility of 

Health plans that choose to contract with external organizations for pharmacy services typically

contract with pharmacy benefit managers (PBMs). Functions that a PBM typically performs for a

health plan include

1. Managing the costs of prescription drugs

2. Promoting efficient and safe drug use

3. Determining the health plan’s internal management responsibilities for pharmacy services