All Home Health Agencies must provide skilled nursing services and at least one of the following therapeutic services: physical therapy, speech language pathology or occupational therapy, medical social services, or home health aide services in a place of residence used as a patient's home. The Home Health Agency must provide at least one of these services directly and in its entirety by employees of the Home Health Agency.

Starting the process

Home care providers seeking Medicare certification will need to complete the following forms:

CMS-1572 (a and b) (PDF)
CMS-1561 (PDF)
Complete the Civil Rights Attestation and the Assurance of Compliance form at US Office of Civil Rights Assurance of Compliance.

Email or mail these documents 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

Submit Outcome and Assessment Information Set (Oasis) transmission.
CMS 855A Medicare Enrollment Application (PDF) all supporting documentation will be sent to the designated Medicare Administrative Contractor (MAC) for approval.(See Medicare Fee-for-Service Provider Enrollment Contact List)

MDH will proceed with the initial Medicare certification process when we have received the above forms, verified Oasis submission and received the approval letter and CMS-855 from the MAC.

Onsite Medicare survey

When above documents are complete, MDH will send a questionnaire asking to acknowledge that you are ready for an initial Medicare survey. You can choose to have MDH conduct the initial certification survey or you can choose to have a Region V Office of CMS-approved accrediting organization conduct the initial survey. (See CMS-approved Accrediting Organizations (PDF).)

If you choose to have MDH conduct the initial certification survey you will need to have provided skilled care to a minimum of 10 patients. At least 7 of the 10 required patients should be receiving care from the home health agency at the time of the initial Medicare survey.

If no deficiencies are issued at the time of the initial certification survey, MDH will recommend Medicare certification to Region V Office of CMS effective the date of the survey.
If deficiencies are issued, a plan of correction will be required. If the plan of correction is accepted, MDH will recommend Medicare certification to Region V Office of CMS effective the date the acceptable plan of correction is received in this office.
If at the time of the initial survey you have not met the Conditions of Participation, MDH will recommend denial of Medicare certification to Region V Office of CMS. Region V Office of CMS will deny certification and you will need to reapply.

MDH will process the initial certification survey documents, the approved 855A and federal forms with our recommendation to Region V Office of CMS. Region V Office of CMS will review the application. If approved, Region V Office of CMS will send you an approval letter with the CMS Certification Number (CCN).

If you choose to have the Region V Office of CMS-approved Accrediting Organization conduct the initial survey, MDH will need a copy of the approval letter from the Accrediting Organization. MDH will forward the approval letter from the Accrediting Organization, the approved 855A and federal forms to Region V Office of CMS with our recommendation. Region V Office of CMS will review the application and if approved, Region V Office of CMS will send an approval letter with the CMS Certification Number (CCN).

The State Operations Manual - Chapter 2 - Organization of HHA - Chapter 2182 (PDF) provides detailed information about initial Home Health Agency certification.