Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391
Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 713026 (X3) Date Survey Completed 09/02/2025
Name of Provider or Supplier Bogalusa Rehabilitation Hospital Street Address, City, State 621 Columbia Street, Bogalusa, LA
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
(X4) ID Prefix Tag Summary Statement of Deficiencies

(Each deficiency should be preceded by full regulatory or LSC identifying information)
A0815 DISCHARGE PLANNING-D/C PLANNING LIST

[The hospital must] include the discharge planning a list of HHA’s, SNF’s, IRF’s, or LTCH’s that are available to the patient, that are participating in the Medicare program, and that serve the geographic area(as defined by the HHA) in which the patient resides, or in the case of a SNF, IRF, or LTCH, in the geographic area requested by the patient. HHAs must request to be listed by the hospital as available. (i) The list must only be presented to patients for whom home health care post hospital extended care services, SNF, IRF, or LTCH services are indicated and appropriate as determined by the discharge planning evaluation. (ii) For patients enrolled in managed care organizations, the hospital must make the patient aware of the need to verify with their managed care organization which practitioners, providers or certified suppliers are in the network of the patient’s managed care organization, it must share this with the patient or the patient’s representative. (iii) [The hospital must] document in the patient’s medical record that the list was presented to the patient or to the patient’s representative.….


This STANDARD is not met as evidenced by:
Based on record review and interview the hospital failed to document in the patient's medical record that a list of HHA's, SNF's, IRF's, or LTCH's available to the patient participating in the Medicare program was presented to 3 (#1-#3) of 3 (#1-#3) patients sampled. Findings: Patient #1 Review of medical record revealed an admit date of 08/15/2025 with diagnosis other Neurologic Conditions. Primary insurance was Medicare. Patient was discharged on 08/25/2025 to a group home owned by S3SW. Continued review failed to reveal Patient #1 was presented with a list of HHA's, SNF's, IRF's, or LTCH's available to this patient participating in the Medicare program. During an interview on 08/28/2025 at 1:30 PM in the presence of S2DON, S3SW stated she and brother were the owners of the group home that Patient #1 was discharged to on 08/25/2025. During an interview on 09/02/2025 at 3:20 PM, S3SW confirmed Patient #1 lived in the group home she owned. S3SW does not remember if she showed the list of HHA's, SNF's, IRF's, or LTCH's available to this patient participating in the Medicare program but she thought she did. During an interview on 09/02/2025 at 2:45 PM, S2DON confirmed that Patient #1's medical record failed to reveal evidence that she was provided a list of HHA's, SNF's, IRF's, or LTCH's available to her who was a participant in the Medicare program. Patient #2 Review of medical record revealed an admit date of 08/18/2025 with diagnosis other Neuromuscular Conditions. Primary insurance was Medicare. Patient was discharged on 08/26/2025 to a friend's home. Continued review failed to reveal Patient #2 was presented with a list of HHA's, SNF's, IRF's, or LTCH's available to this patient participating in the Medicare program. During an interview on 09/02/2025 at 1:20 PM, S2DON confirmed that Patient #2's medical record failed to reveal evidence that he was provided a list of HHA's, SNF's, IRF's, or LTCH's available to him who was a participant in the Medicare program. Patient #3 Review of medical record revealed an admit date of 07/01/2025 with diagnosis Parkinsonism. Primary insurance was Medicare. Patient was discharged on 07/11/2025 to a group home. Continued review failed to reveal Patient #3 was presented with a list of HHA's, SNF's, IRF's, or LTCH's available to this patient participating in the Medicare program. During an interview on 09/02/2025 at 2:12 PM, S2DON confirmed that Patient #3's medical record failed to reveal evidence that she was provided a list of HHA's, SNF's, IRF's, or LTCH's available to her who was a participant in the Medicare program. During an interview on 09/02/2025 at 2:50 PM, S2DON confirmed S3SW's group home was not on the list of HHA's, SNF's, IRF's, or LTCH's available to patients who participant in the Medicare program.