Adding or Changing Service Area to a Medicare-certified Home Health Agency

A Medicare-certified home health agency that wants to add or change a service area will provide written notification of the following:

• Name and address of the agency
• Health Facility Identification Number (HFID)
• CMS Certification Number (CCN)
• Previously approved service area (counties)
• Service area (counties) you have added, changed or deleted
• Notice will be signed by Home Health Agency official

Written notification 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

Submit the CMS 855A to the Medicare Administrative Contractor (MAC) for the change of the service area.

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

MDH will not approve the new counties you have added to your service area until after we have received an approval letter from the MAC.

If MDH approves of the expansion or change in service area, we notify the Region V Office of CMS who will then issue a tie-in notice to the MAC so you can bill for the services in the new service area.