August 14, 2015

Our Reference: CCN 454081
Shelah A. Adams, CEO
Timberlawn Mental Health System
4600 Samuell Blvd
Dallas, TX 75315
Dear Ms. Adams:
The Centers for Medicare & Medicaid Services (CMS) notified you on July 23, 2015, that Timberlawn
Health System would be terminated from the Medicare program on August 7, 2015, because of
deficiencies that represented an immediate jeopardy to patient health and safety. On August 5, 2015,
we sent you a notice that the termination date was extended to August 13, 2015, to accommodate the
Federal court hearing on August 11, 2015.
This is to notify you that the Medicare provider agreement of Timberlawn Mental Health System
terminated at 12:01 a.m., on August 14, 2015. Please refer to our July 23, 2015, letter for your appeal
rights. No payment for patients admitted on or after that time and date will be made by the Medicare
program. For patients admitted prior to August 14, 2015, payment may continue to be made for up to 30
days of covered inpatient hospital services furnished on and after August 14, 2015.
A list with the names and health insurance claim numbers of the Medicare patients remaining in your
hospital on August 14, 2015, must be forwarded immediately to the Centers for Medicare & Medicaid
Services, Division of Survey and Certification, Attention: Ginger Odle, 1301 Young Street, Room 827,
Dallas, TX 75202.
You may contact Dodjie Guioa at 214-767-6179 or by e-mail, if you have
questions regarding this matter.

Ginger Odle, Manager
Enforcement Branch
Enclosure: CMS-2567
cc: Accrediting Organization, DSHS