LAKE PROVIDENCE, LA — Federal health inspectors cited Cypress at Lake Providence nursing home for failing to provide a resident with legally required Medicare coverage notices before terminating their skilled nursing benefits, according to a deficiency report completed May 21, 2025.
Facility Ended Medicare Coverage Without Required Notifications
During a standard health inspection, surveyors discovered that Cypress at Lake Providence initiated the discharge of a resident — identified as Resident #16 — from Medicare Part A skilled nursing services while the resident still had unused benefit days remaining. The resident's Part A episode began on January 5, 2025, with the last covered day recorded as February 3, 2025.
Federal regulations require nursing facilities to provide two specific notification forms before terminating Medicare-covered services: the Skilled Nursing Facility Advanced Beneficiary Notice of Non-Coverage (CMS-10055) and the Notice of Medicare Non-Coverage (CMS-10123). Neither form was documented in Resident #16's medical record.
These forms are not optional paperwork. They serve a critical protective function for nursing home residents receiving Medicare-funded care. The CMS-10055 informs residents in advance that their facility believes Medicare may not cover continued services and explains the potential financial liability. The CMS-10123 provides formal notice that Medicare coverage is ending and — most importantly — outlines the resident's right to request an expedited appeal through a Quality Improvement Organization.
Without these documents, a resident has no formal notification that their coverage is being discontinued, no written explanation of why, and no clear pathway to challenge the decision.
What These Missing Forms Mean for Residents
When a nursing facility initiates a discharge from Medicare Part A services — particularly when benefit days have not been exhausted — the resident is placed in a vulnerable position. Medicare Part A covers skilled nursing facility care for up to 100 days per benefit period, with full coverage for the first 20 days and a daily copayment for days 21 through 100.
A facility-initiated termination of these benefits before days are exhausted raises a fundamental question: was the resident informed that they could dispute this decision? The appeal process exists specifically for situations where residents or their families believe skilled services are still medically necessary. An expedited review must be completed within 72 hours of the request, providing a rapid safeguard against premature benefit termination.
In this case, Resident #16 remained at the facility after the Medicare discharge, meaning they continued to need some level of care. The transition from Medicare-covered skilled services to a different payment arrangement can result in significant out-of-pocket costs or a shift to Medicaid coverage with different service levels.
Staff Confirmed Missing Documentation
During an interview on May 20, 2025, at 11:02 a.m., the facility's Clinical Reimbursement Specialist, identified as S14, confirmed she was unable to locate the completed CMS-10055 and CMS-10123 forms for Resident #16. The deficiency was classified at a level of minimal harm or potential for actual harm, affecting few residents.
The inspection reviewed three residents (#8, #16, and #322) for proper handling of Medicare Part A service terminations. Resident #16 was the one for whom documentation failures were identified.
Federal Standards Require Timely Written Notice
Under federal regulations governing skilled nursing facilities, the notification process follows a specific timeline. The NOMNC must be delivered at least two days before Medicare-covered services end, giving the resident adequate time to understand the change and pursue an appeal if desired. The advance beneficiary notice must clearly state the services that may not be covered and the reasons the facility believes coverage will end.
These requirements exist because Medicare beneficiaries in skilled nursing facilities are often dealing with serious medical conditions and may not independently understand changes to their coverage status. Written notice in plain language, delivered within mandated timeframes, is the established standard of practice.
The deficiency was one of multiple citations issued during the May 2025 inspection. The full survey report, which spans 39 pages, details additional findings across the facility's operations.
Families with residents at Cypress at Lake Providence can review the complete inspection report through the Centers for Medicare and Medicaid Services Care Compare website or contact the Louisiana Department of Health for further information.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Shady Lake Nursing Home from 2025-05-21 including all violations, facility responses, and corrective action plans.
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