Closure or Voluntary Termination Process for Medicare-certified Home Health Agencies

A Medicare-certified home care agency that closes will provide the following:

• Written notice on agency letterhead. The written notice shall include:
• Health Facility Identification Number (HFID)
• CMS Certification Number (CCN)
• Date the agency is voluntarily terminating Medicare Certification
• Specify whether the agency will or will not remain licensed
• Notice will be signed by Home Health Agency official

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

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

Written notice 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

CMS 855A application and all supporting documentation should be submitted to the designated Medicare Administrative Contractor (MAC) for the closure.

• CMS 855A Medicare Enrollment Application (PDF)
• (See Medicare Fee-for-Service Provider Enrollment Contact List)

MDH will forward documents to CMS of the closure when the written notice and the approval letter and CMS-855A from the MAC are received.