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Home Health Agency – Branch Location

If you are interested in opening a branch location please see the list of items to be submitted (link below) to the Office of Healthcare Licensing and Surveys (OHLS), along with a written request to add a branch location. You will also need to complete a new license application with appropriate fee to add the branch. We will review the information and submit a request to the Centers for Medicare & Medicaid Services Regional Office (CMS-RO) for approval or denial. 

You are also subject to complete an updated and appropriate CMS-855 form. It is your responsibility to contact the appropriate fiscal intermediary (FI) or carrier for the appropriate application. 

The CMS website:, contains a list of the FIs and carriers as well. Questions regarding this application must be directed to the FI or carrier. Once you have received and completed the application form, you must submit it directly to the FI or carrier. Our office will be notified by the FI or carrier of their review and recommendations to CMS with regard to your application.  Until such time OHLS cannot make a recommendation to the CMS-Regional Office.

If you have questions or need further information, please feel free to contact the Office of Healthcare Licensing and Surveys at (307) 777-7123.

Home Health Agency Branch License Application: contact Tammy Schmitt via e-mail

Home Health Agency Branch Checklist:   Word Format   PDF Format