[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR405.505]



[Page 116]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 405_FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED--Table of 

Contents

 

          Subpart E_Criteria for Determining Reasonable Charges

 

Sec. 405.505  Determination of locality.



    ``Locality'' is the geographical area for which the carrier is to 

derive the reasonable charges or fee schedule amounts for services or 

items. Usually, a locality may be a State (including the District of 

Columbia, a territory, or a Commonwealth), a political or economic 

subdivision of a State, or a group of States. It should include a cross 

section of the population with respect to economic and other 

characteristics. Where people tend to gravitate toward certain 

population centers to obtain medical care or service, localities may be 

recognized on a basis constituting medical services areas (interstate or 

otherwise), comparable in concept to ``trade areas.'' Localities may 

differ in population density, economic level, and other major factors 

affecting charges for services. Carriers therefore shall delineate 

localities on the basis of their knowledge of local conditions. However, 

distinctions between localities are not to be so finely made that a 

locality includes only a very limited geographic area whose population 

has distinctly similar income characteristics (e.g., a very rich or very 

poor neighborhood within a city).



[57 FR 27305, June 18, 1992]