Legal Entity Name Change Process for Medicare-certified Home Health Agencies

Not a change of ownership

A Medicare-certified home care agency that has a legal entity name change will provide the following:

• Health Facility Identification Number (HFID)
• CMS Certification Number (CCN)
• Doing Business As (DBA) name
• Previous legal entity name
• New legal entity name
• Date of change
• Notice will be signed by home health agency official

Contact the Minnesota Secretary of State and file a Certificate of Assumed Name. See Minnesota Secretary of State: Assumed Names/Sole Proprietorships.

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

MDH cannot recommend the legal entity name change until after we have received a copy of the approval letter from the accrediting organization.
CMS-approved Accrediting Organizations (PDF)

Completed documents and supporting documentation should be emailed or mailed to:
Minnesota Department of Health
Health Regulation Division
P.O. 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 approval.

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

MDH will not process the legal entity name change until after the facility notice, 855A and approval letter from the Medicare Administrative Contractor are received.