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.

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Advocacy Opportunity Cost Containment

Alaska Finalizes 2026 Fee Schedule Recommendations

Recommended changes will be reviewed by the WCB and MSRC on August 22nd, with final adoption expected in October, and taking effect in 2026.

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August 18, 2025

Claim Costs Industry Data

WCRI Publishes New Study on High-Cost Back and Shoulder Injuries

Reviewing 194,000 claims, the report found that claims with degenerative comorbid conditions are 58% more likely to become a high-cost claim.

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August 11, 2025

Advocacy Opportunity Mental Health Presumptions Treatment Guidelines

Washington State Issues Draft of PTSD Clinical Guidelines

Open to public comment until September 12th, the guideline is intended to establish best practices for diagnosis and treatment.

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August 11, 2025

Mental Health Presumptions

Minnesota Releases PTSD Report

At over 200 pages, this comprehensive report includes a review of PTSD claims in the workers’ comp system.

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August 11, 2025

Marijuana

Pennsylvania Proposes Cannabis Reimbursement Bill

If enacted, insurers would be required to reimburse up to $250 per month for qualified medical use.

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August 11, 2025

Worker Safety

Senate Introduces Federal Heat Standard Bill

If enacted, OSHA would be required to adopt a federal standard for enforceable protections.

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August 11, 2025

Cost Containment

South Dakota Approves Rulemaking for Physician Fee Schedule

The 2025 Optum RVPs for medical services and treatments will be adopted, but with current conversion factors.

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August 11, 2025

Claim Costs Industry Data

NCCI Reports on Medical Inflation Highlights

While overall medical inflation remains low, certain tariffs are still pending, which could impact long-term costs.

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August 4, 2025

Claim Costs Cost Containment Industry Data

California Publishes 2025 State of the System Report

Medical costs went up 8% in 2024, driven by increased utilization, fee schedule inflation, and growth in medical-legal services.

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August 4, 2025

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Further resources you may be interested in

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

Expert Q&A: Cybersecurity Tactics in Workers’ Compensation

RxInformer editors sat down with Healthesystems’ AVP of Information Security and resident cybersecurity expert, Tony Brown, to discuss how cyber threats affect workers’ comp organizations.

Drug Pricing Legislation and Its Impact on Workers' Comp

Lawmakers look to regulate the U.S. drug supply chain in ways that could impact workers’ comp pharmacy management.

High Prices, High Impact: Meet the Drugs Driving Up Claim Costs in Workers’ Comp

High-impact drugs, including topicals and compounds, represent proportionately low utilization compared to opioids or NSAIDs, but they can increase pharmacy spend exponentially on impacted claims.