Closure Process for Medicare-certified Home Health Agency (HHA) Parent

Email written notice on letterhead and include the following:

• Written notice on agency letterhead. The written notice shall include:
  • Health Facility Identification Number (HFID)
  • CMS Certification Number (CCN)
  • Name and address
  • Effective date of closure 
  • Specify whether the agency will remain licensed
  • Notice will be signed by HHA official

If deemed status, the Medicare-certified HHA  will notify the accrediting organization.

Email address: Health.HRD-FedLCR@state.mn.us

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

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

MDH will forward documents to CMS of the closure when the written notice and the approval letter and CMS-855A from the MAC are received.

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/som107c02.pdf