OMB control number

Medicare Part C and Part D Program Audit Protocols (CMS-10717)

OMB 0938-1395 · HHS/CMS.

OMB 0938-1395

42 CFR 422.502 describes CMS' regulatory authority to evaluate, through inspection or other means, Medicare Advantage Part C organizations. These records include books, contracts, medical records, patient care documentation and other records that pertain to any aspect of services performed, reconciliation of benefit liabilities, and determination of amounts payable. 42 CFR 423.503 states that CMS must oversee a Part D plan sponsor's continued compliance with the requirements for a Part D plan sponsor. 423.514 states that the Part D plan sponsor must have an effective procedure to develop, compile, evaluate, and report to CMS, to its enrollees, and to the general public, at the times and in the manner that CMS requires, statistics regarding areas such as cost of operations, patterns of utilization availability, accessibility, and acceptability of services. CMS developed a strategy to address our oversight and audit responsibilities within the context of limited audit/oversight resources. We have combined all Part C and Part D guides into one universal guide promoting efficiency and effectiveness and reducing financial and time burdens for both CMS and Medicare-contracting entities.

The latest form for Medicare Part C and Part D Program Audit Protocols (CMS-10717) expires 2027-01-31 and is listed under ICR 202310-0938-002.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form CMS-10717 Independent Validation Auditor (IVA) Validation Report	Form and Instruction
Form CMS-10717 CMS Request for Additional Information (RAI)/Sponsor Response	Form and Instruction
Form CMS-10717 Attendance Log for Meetings/Webinars/Conferences	Form
Form CMS-10717 Independent Validation Audit Work Plan	Form and Instruction
Form CMS-10717 Root Cause Analysis	Form and Instruction
Form CMS-10717 Formulary and Benefits Administration (FA) Root Cause Analysis and Impact Analysis	Form and Instruction
Form CMS-10717 Organization Determinations, Appeals, and Grievances (ODAG) ODAG Timeliness Mitigation Analysis (ODAG-TMA)	Form and Instruction
Form CMS-10717 Part C Organization Determinations, Appeals, and Grievances (ODAG)Classification of Requests Root Cause Analysis and Impact Analysis	Form and Instruction
Form CMS-10717 Part C Organization Determinations, Appeals, and Grievances (ODAG) Processing of Coverage Requests Root Cause Analysis and Impact Analysis	Form and Instruction
Form CMS-10717 Special Needs Plans Care Coordination (SNPCC) HRA Timeliness Mitigation Analysis (HRA-TMA)	Form and Instruction
Form CMS-10717 Special Needs Plans Care Coordination (SNPCC) Root Cause Analysis and Impact Analysis	Form and Instruction
Form CMS-10717 Part D Coverage Determinations, Appeals, and Grievances (CDAG) Classification of Requests Root Cause Analysis and Impact Analysis	Form and Instruction
Form CMS-10717 Part D Coverage Determinations, Appeals, and Grievances (CDAG) Processing of Coverage Requests Root Cause Analysis and Impact Analysis	Form and Instruction
Form CMS-10717 Special Needs Plans - Care Coordination Supplemental Questionnaire	Form and Instruction
Form CMS-10717 Part D Formulary and Benefit Administration (FA) Supplemental Questionnaire	Form and Instruction
Form CMS-10717 Compliance Program Effectiveness (CPE) Customized Organizational Structure and Governance PowerPoint Presentation	Form and Instruction
Form CMS-10717 Compliance Program Effectiveness (CPE) Compliance Oversight Questionnaire	Form and Instruction
Form CMS-10717 Pre Audit Issue Summary	Form
CMS-10717_SupportingStatementA_.docx	Supporting Statement A
60-day comments.pdf	Public Comments
CMS10717_ResponseTo60DayComments.pdf	Supplementary Document
CombinedMasterCrosswalk_60day.pdf	Supplementary Document
Yearly Industry-Wide Timeliness Monitoring Project (TMP)	Information collection
Program Audits	Form and Instruction
Program Audits	Form and Instruction
Program Audits	Form
Program Audits	Form and Instruction
Program Audits	Form and Instruction
Program Audits	Form and Instruction
Program Audits	Form and Instruction
Program Audits	Form and Instruction
Program Audits	Form and Instruction
Program Audits	Form and Instruction
Program Audits	Form and Instruction
Program Audits	Form and Instruction
Program Audits	Form and Instruction
Program Audits	Form and Instruction
Program Audits	Form and Instruction
Program Audits	Form and Instruction
Program Audits	Form and Instruction
Program Audits	Form
Program Audits	Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202606-0938-024	Revision of a currently approved collection	2026-07-06
202310-0938-002	Extension without change of a currently approved collection	2023-10-17	Approved without change
202006-0938-004	New collection (Request for a new OMB Control Number)	2020-06-05	Approved with change

OMB Details

Program Audits

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
Form	Name	Electronic access	Type
Form CMS-10717	Part D Formulary and Benefit Administration (FA) Supplemental Questionnaire	Fillable Printable	Form and instruction
Form CMS-10717	CPE Compliance Officer Questionnaire Compliance Officer Questionnaire (CO-Q)	Fillable Printable	Form and instruction
Form CMS-10717	Pre Audit Issue Summary	Fillable Printable	Form
Form CMS-10717	Attendance Log for Meetings/Webinars/Conferences	Fillable Printable	Form and instruction
Form CMS-10717	Special Needs Plans - Care Coordination Supplemental Questionnaire	Fillable Printable	Form and instruction
Form CMS-10717	Root Cause Analysis	Fillable Printable	Form
Form CMS-10717	Independent Validation Audit Work Plan	Fillable Printable	Form and instruction
Form CMS-10717	First Tier, Downstream, and Related Entities Operations Oversight Questionnaire	Fillable Printable	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.