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Stephen M. Elwell

Stephen Elwell is a partner with Gjerset & Lorenz, LLP, where he focuses on assisting institutional healthcare providers, including hospitals, nursing homes, residential treatment facilities and freestanding psychiatric hospitals, related to their operations and their participation in private and governmental reimbursement programs. He began his work at Gjerset & Lorenz as a summer associate and law clerk before joining the firm as an associate in 2005.

Mr. Elwell’s practice has recently emphasized the design, development and operation of new Medicaid supplemental payment programs that enable providers to reduce the gap between their entitlement and reimbursement.  Mr. Elwell has also:

  • Advised numerous Texas hospitals related to their participation in state and local indigent care programs, as well as the 1115 Medicaid Transformation Waiver and its associated Uncompensated Care program.
  • Assisted hospitals in several states to form non-profit corporate entities, maintain these entities in compliance with state law, and secure appropriate licensure for these entities’ provision of healthcare services.
  • Drafted and negotiated hundreds of agreements between hospitals, physicians and other healthcare organizations and professionals.
  • Structured and restructured hospital and physician relationships to ensure their consistency with state and federal prohibitions on the payment of consideration to induce physician referrals (Stark and Anti-Kickback laws).
  • Advised numerous hospitals in multiple states related to their participation in the Medicaid Disproportionate Share Hospital program, including qualification analysis, hospital compliance reporting, administrative appeals of agency determinations and projections of future revenues.
  • Advised hospitals and non-hospital providers regarding the implications of state and local government obligations on the services offered by private providers, including the implications of sovereign immunity, federal grant obligations, state budgetary restrictions and requirements under governmental services programs.
  • Assisted hospitals in the development and redesign of charity care and bad debt policies in order to more accurately reflect hospital operations while maintaining consistency with state and federal limitations.
  • Assisted in the due diligence analysis for several hospital acquisitions related to the viability of current Medicaid revenue streams and the identification of opportunities for additional sources of revenue after acquisition.
  • Helped freestanding psychiatric hospitals and residential treatment facilities in several states to develop and propose Medicaid reimbursement methodologies that more appropriately reimburse the unique costs borne by these facilities.
  • Represented several hospitals in arbitration and litigation for the recovery of systemic underpayments from managed care organizations.
  • Drafted lease agreements, management agreements, option agreements, promissory notes and security agreements related to the transfer of ownership interests for hospitals.
  • Advised several hospitals related to their participation in healthcare reforms through a Delivery System Reform Incentive Payment program implemented under an 1115 Waiver.
  • Structured, developed, and assisted hospitals, working with Medicaid managed care organizations and the State Medicaid agency, to implement a program to incentivize reforms and improvement of health and outcomes for the Medicaid managed care population.

Education

  • University of Texas School of Law, J.D., 2005
  • University of Texas, B.B.A. in Management Information Systems, Minor in Finance, 2002

Professional Affiliations

  • Past Secretary, Member, Austin Health Lawyers Association
  • Member, American Health Lawyers Association
  • Member, American Bar Association

Speaking Engagements

  • Texas Private Hospital Medicaid Supplemental Payment Programs, Texas Indigent Health Care Association, October 14, 2010.
  • Hospital Charity Care Guidelines and Reporting, Texas Association for Healthcare Financial Administration, March 22, 2010.
  • The Changing Medicaid Landscape, Healthcare Financial Management Association – Texas Gulf Coast Chapter, October 20, 2006.

Publications

  • Preemption of Contract Claims by the Medicare Act: An Analysis of the Recent Holding In Lifecare Hospitals v. Ochsner Health Plan, REVIEW OF LITIGATION, Vol. 24, p. 127 (positively cited by the Texas Supreme Court in Christus Health Gulf Coast, et. al., v. Aetna Inc., et. al., 237 S.W.3d 338, 343 (Tex. 2007) and the United States District Court for the Western District of New York in Canandaigua Emergency Squad, Inc., et.al., v. Rochester Area Health Maintenance Organization, Inc., 2011 WL 43268 (Jan. 6, 2011))