Change of Ownership Process for Medicare-certified Home Health Agencies

The new owners must have the same location, same service area and provide the same services exactly as the previous owner.  

A Medicare-certified home health agency that has a change of ownership will provide the following:

• As the new owner, submit a completed application for Change of Ownership: Comprehensive Home Care License and license fee to MDH prior to the change of ownership date. See Home Care and Assisted Living Changes of Ownership.

• Submit copies of legal documents signed and dated by both parties substantiating the parties involved and the effective date of the change of ownership.

• Complete the following Medicare forms:
• CMS-1572 (a and b) (PDF)
• CMS-1561 Health Insurance Benefit Agreement (PDF)
• Complete the Civil Rights Attestation and the Assurance of Compliance form.

Completed documents should be emailed or mailed to:
Minnesota Department of Health
Health Regulation Division
Licensing and Certification Program
PO 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) (must be completed by both the buyer and the seller)
• (See Medicare Fee-for-Service Provider Enrollment Contact List)

MDH will not proceed with the change of ownership until after we have received a copy of the 855A and approval letter from the MAC.

When we have received all of the documents, MDH will review the documents and make a recommendation to the Region V Office of CMS. If approved, the Region V Office of CMS will send an approval letter to the facility.