Notification of Key Staff Changes at Medicare-certified Home Health Agencies

If you have changes in the following positions, you need to notify MDH:

Administrator
Director of Nursing
President Governing Board
Board Members
Managing Agent

Provide written notice on letterhead and include the following:

• Health Facility Identification Number (HFID)
• CMS Certification Number (CCN)
• Name and address of provider
• Change that has occurred
• Date of change
• Letter signed by authorized official

Letter can be emailed or mailed to:

Minnesota Department of Health
Health Regulation Division
Licensing and Certification Program
P.O. Box 64900
St. Paul, MN 55164-0900
Attn: Certification Specialist
Email address: health.HRD-FedLCR@state.mn.us