Request to Provide Services Across State Lines for Medicare-certified Home Health Agencies

A Medicare-certified home care agency that wishes to provide services across state lines must provide the following:

• Written notification to MDH of its proposal to provide services on an interstate basis.
• Applicable State licensure, personnel licensure and other State requirements from the respective state.

If deemed status, the home health agency must notify the accrediting organization.
CMS-approved Accrediting Organizations (PDF)

If deemed status, MDH will not process the request to provide service across state lines until after we have received a copy of the approval letter from the accrediting organization.

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 approval. 

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

MDH will not recommend your proposal to provide services across state lines until after we have received a copy of the 855A and approval letter from your fiscal intermediary.

MDH and the state agency involved must have a written reciprocal agreement permitting the home health agency to provide services in this manner.

It is at the discretion of MDH and the state agency involved if a reciprocal agreement is in the best interest of their residents, provider markets, and quality assurance and oversight systems.

CMS will review the required reciprocal agreement between the states and supporting documentation and make a determination.