Absolute Free AHM-540 Exam Practice for Comprehensive Preparation 

A health plan’s coverage policies are linked to its purchaser contracts. The following statement(s) can correctly be made about the purchaser contract and coverage decisions: 1. In case of conflict between the purchaser contract and a health plan’s medical policy or benefits administration policy, the contract takes precedence 2. Purchaser contracts commonly exclude custodial care from their coverage of services and supplies 3. All of the criteria for coverage decisions must be included in the purchaser contract  

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 

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 

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

1. Case management incorporates activities that may fall outside a health plan’s typical

responsibilities, such as assessing a member’s financial situation

2. Case management generally requires a less comprehensive and complex approach to a course

of care than does utilization review

3. Case management is currently applicable only to medical conditions that require inpatient

hospital care and are categorized as catastrophic in terms of health and/or costs