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Compliance Program Effectiveness Self-Assessment …

ATTACHMENT I-A. MEDICARE ADVANTAGE AND PRESCRIPTION DRUG Compliance Program Effectiveness self - assessment QUESTIONNAIRE (SAQ). (Rev. 5. 10-2015). Name of Sponsoring Organization: MA-PD/PDP Contract Numbers: Name/Title of Person Completing assessment : Date of assessment : Note: Sponsoring Organizations should not interpret every question as a mandatory CMS requirement, but rather as a guide in evaluating the Effectiveness of their Compliance Program . While Element V of the Medicare Part C and D Compliance Program Guidelines Well Publicized Disciplinary Standards is a required and critical component of a Compliance Program , it has been omitted from this version of the SAQ. This version of the SAQ is a tool to be used with the 2015/2016 Compliance Program Effectiveness Audit Protocol. However, sponsoring organizations must ensure structures and procedures are in place to successfully implement all required elements of a Compliance Program .

Directions for completing the self-assessment questionnaire: This document will help your organization evaluate the effectiveness of your Medicare Compliance Program. Please respond to each question according to the current status of your Compliance Program. If the answer is “YES” to any question below, check the

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