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A significant part of the Healthesystems vision is to create a more integrated experience for our customers

Advocacy & Compliance

Healthesystems’ Advocacy & Compliance experts are essential in the management of pharmacy and ancillary benefits for our clients. By tracking and influencing regulatory activity, our team stays ahead of evolving trends and identifies opportunities to advocate on behalf of our clients, their injured workers, and the broader industry.

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The Advocacy &  Compliance Team

Monitors and reports on proposed and pending regulatory changes that impact workers' comp, helping shape effective program strategies

Advocates for fair and balanced public policy through proactive engagement with regulators, customers, and other stakeholders throughout the rulemaking lifecycle

Supports operational compliance by providing guidance to internal stakeholders and external partners during the implementation of new regulatory changes

Regulatory Recap

A weekly e-newsletter informed by the Advocacy & Compliance team to help keep our clients and industry contacts in the know on the latest legislation and policy updates impacting workers’ comp.

Cost Containment

Louisiana Proposes a Workers’ Comp Fee Schedule

The bill could require biennial updates, utilizing RVUs form the resource-based relative value scale (RBRVS).

April 14, 2025

California Releases Report on Independent Medical Reviews

A total of 199,651 IMR applications were received in 2024, with pharmaceuticals making up 32.7%.

April 14, 2025

Advocacy Opportunity Cost Containment Treatment Guidelines

California P&T Committee to Meet on April 16th

The hybrid meeting will cover the pharmacy fee schedule, biosimilars, cannabis coverage, and payments for topical drugs.

April 14, 2025

Psilocybin Bills Enacted in Colorado and North Dakota

Colorado’s bill allows for prescription of psilocybin upon an FDA-approved product, while North Dakota lists psilocybin as a Schedule IV drug.

April 7, 2025

Montana Could Recognize Physical Therapists as Treating Physicians

Passing both chambers nearly unanimously, Senate Bill 109 currently sits with the governor.

April 7, 2025

Billing & Payments

Florida Discusses Provider Reimbursement at Stakeholder Meeting

Healthesystems attended the meeting to capture key discussion updates.

April 7, 2025

Mental Health Presumptions

Connecticut Proposes Expansion to PTSD Presumption

A new qualifying event would include witnessing a serious physical injury that does not result in death or permanent disfigurement.

April 7, 2025

Billing & Payments Cost Containment

California Considers Updates to Billing Disputes Over Contracted Discounts

These disputes would qualify for independent bill review, and contracts must be presented when justifying payments below fee schedule.

April 7, 2025

Claim Costs Industry Data

WCRI Publishes Study on Degenerative and Comorbid Conditions

Approximately 38.8% of claims had one or more comorbidities, based on an analysis of 930,000 claims with at least 7 days lost time across 32 states.

April 7, 2025

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Further resources you may be interested in

Additional articles and updates from Healthesystems related to policy shaping workers’ comp.

Side Effects: COVID-19-Related Healthcare and Pharmacy Trends

With the pandemic disrupting the healthcare system, how has workers’ comp been impacted?

U.S. Executive Order Signed for Telemedicine

A wide-sweeping order on national telehealth policy requires federal agencies to begin making plans for change.

Florida COVID-19 Report

Data from nearly 12,000 COVID-19 claims breaks down coverage among industries, telemedicine insights, and more.

Workers’ Comp Industry Insights Survey

2020 has been a year of disruption, and we want to know what the industry thinks about COVID-19, telehealth, opioids, AI, and more!

COVID-19 Telehealth Updates

Telehealth extensions in Colorado, Texas, and New York.

FDA Issues Naloxone Recommendations for Opioids and OUD Drugs

The FDA recommends healthcare professionals co-prescribe the opioid overdose reversal drug with all opioid prescriptions.

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Workers' Comp Property and Casualty PBM
Expires 01/01/2028