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State Licensure and/or Federal Medicare Certification

Hospice Agency Application Materials

If your application is in accordance with Pennsylvania state licensure rules and regulations, the Division will issue you a license. Please keep in mind the length of time for the licensure process depends upon the accuracy of information provided.

Hospice Agency Application for Federal Medicare Certification

NOTE: State licensure as a home health agency is a requirement for federal certification.

After review and acceptance of the application materials and notification from CMS of the approval of the CMS-855A, the department will conduct a survey before recommending the agency for Medicare certification.

Mail completed forms to:
Please note change of address
Pennsylvania Department of Health
555 Walnut St.
7th Floor, Suite 701
Harrisburg, PA 17101

Call 717-783-1379