US · guidance
CMS Pub. 100-16, ch. 8, § 10.3
Payment Areas
MA local area. The MA local area is the payment area for MA local plans. The MA local
area is defined at 42 CFR 422.252 as a county or an equivalent geographic area specified
by CMS.
MA region. The MA region is the payment area for a MA regional plan. The MA regions
are established by CMS.
Special payment area for ESRD enrollees. Special payment areas may apply to ESRD
enrollees regardless of whether they belong to a local or regional MA plan. Per 42 CFR
422.204(d), the payment area for ESRD enrollees is a State or other geographic area
specified by CMS.
Effective January 1, 2005, the payment area for ESRD enrollees in dialysis and transplant
status is the State, District of Columbia, or territory. The payment area for ESRD enrollees
in functioning graft (post-transplant) status is the county or equivalent area.
History
(Rev. 89; Issued: 11-02-07; Effective/Implementation: 11-02-07)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
971f7e2f36c3a868be7b33856e45f23570771ab75d7e746ccd2f5f427d53585d
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