Legal Entity Name Change Process for Medicare-certified Home Health Agencies

Legal Entity Name Change Process for Medicare-certified Home Health Agencies

Not a change of ownership

A Medicare-certified home care agency that has a legal entity name change will provide the following:

  • Health Facility Identification Number (HFID)
  • CMS Certification Number (CCN)
  • Doing Business As (DBA) name
  • Previous legal entity name
  • New legal entity name
  • Date of change
  • Notice will be signed by home health agency official

Contact the Minnesota Secretary of State and file a Certificate of Assumed Name. See Minnesota Secretary of State: Assumed Names/Sole Proprietorships.

If deemed status, the Medicare-certified home health agency will notify the accrediting organization of the legal entity name change.

MDH cannot recommend the legal entity name change until after we have received a copy of the approval 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.CM-Cert@state.mn.us

CMS 855A application and all supporting documentation should be submitted to the designated Medicare Administrative Contractor (MAC) for the approval.

MDH will not process the legal entity name change until after the facility notice, 855A and approval letter from the Medicare Administrative Contractor are received.

Updated Wednesday, August 30, 2017 at 09:29AM