Adding Services to the Branch Location of a Medicare-certified Home Health Agency

The branch location must not provide services that are outside of what the parent provides and is approved to provide.

A Medicare-certified home health agency that wants to add services to the parent or branch location will provide the following:

• Complete the Home Health Agency Survey and Deficiencies Report CMS 1572a

If adding a service to a location, include the following:

• Identify the staff person and job description
• Date of hire of individual providing services
• Provide proof of staff qualifications (resume, licensure, aide training, etc.)

If deemed status, the Medicare-certified home health agency will notify the accrediting organization of the change.

If deemed status, MDH cannot recommend the additional services to the location until after we have received a copy of the approval letter from the accrediting organization.
CMS-approved Accrediting Organizations (PDF)

Completed documents should be emailed or mailed to:
Minnesota Department of Health
Health Regulation Division
Licensing and Certification Program
PO Box 64900
St. Paul, MN 55164-0900
Attn: Certification Specialist
Email address: Health.HRD-FedLCR@state.mn.us

MDH will forward the CMS-1572a and supporting documentation to Region V Office of CMS.