Location or Address Change Process for Medicare-certified Home Health Agencies

A Medicare-certified home care agency that is relocating or has an address change will provide the following:

• Health Facility Identification Number (HFID)
• CMS Certification Number (CCN)
• Previous location/address
• New location/address
• Effective date of location/address change
• Verify the distance between previous and new location/address
• Verify there has been no change with home health services provided, staffing, clients or service area
• 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 location/address change.

If deemed status, MDH cannot recommend the change until after we have received a copy of the change 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 location/address.

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

MDH will not process the location/address change until after the facility notice, 855A and approval letter from the Medicare Administrative Contractor are received.