Home Health Agency (HHA) - Change of Location

Email written notice on letterhead and include the following: 

• Health Facility Identification Number (HFID)
• CMS Certification Number (CCN)
• Previous location
• New location
• Effective date of location change
• Verify the distance between previous and new location
• Changes in services provided, staffing, clients or service area, if any
• Notice will be signed by HHA official

Email notice to: health.HRD-FedLCR@state.mn.us

Submit CMS 855A application to the designated Medicare Administrative Contractor (MAC)

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

Any questions, please email Health.HRD-FedLCR@state.mn.us

Refer to Chapter 2 of the State Operations Manual – Home Health Agency  See link below:

https://www.cms.gov/regulations-and guidance/guidance/manuals/downloads/som107c03pdf.pdf