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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.

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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New York Pharmacy Network Bill Vetoed by Governor

The bill would have duplicated existing protections for filling certain prescription out-of-network.
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December 8, 2025

Expanding Access to Care Across the Country

Delaware reported success with a recent bill, while Washington State is undergoing rulemaking and the U.S. Senate introduced a new bill.
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December 8, 2025

Pennsylvania Supreme Court Reviews Drug Pricing Case

The case will examine the Bureau of Workers’ Compensation’s use of RED BOOK for calculating AWP.
Read More →
December 8, 2025

CMS Publishes 2026 Q1 NCCI Edits

Changes will impact DME supplier services, facility outpatient hospital services, and practitioner services.
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December 8, 2025

Delaware and Pennsylvania Expand Medical Data Call Reporting

Insurers with 0.25% of market share must begin sharing data by July 1, 2026, while those with lower market share must begin by January 1, 2027.
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December 8, 2025

Nevada Schedules Workshop to Review Reform Rule Changes

This workshop will cover rules around panel provider lists, delegating follow-up care to physician assistants, and other clerical matters.
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December 8, 2025

Texas Finalizes Designated Doctor Plan-Based Audit

The audit will evaluate the medical necessity and reasonableness of referrals and diagnostic testing ordered by designated doctors.
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November 24, 2025

Florida May Permit Older Physical to Help Establish First Responder Presumptions

Exams from previous employers could be used to demonstrate that workers had no signs of occupational illnesses prior to employment.
Read More →
November 24, 2025

California Publishes 2025 Geo Study

The study explores regional differences in claims patterns and cost drivers across the state.
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November 24, 2025
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 Further resources you may be interested in

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

California Updates Pharmacy Fee Schedule

Among many changes, the state is replacing AWP with a new pricing model.
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Missouri Proposes Bill for Psilocybin Therapy

Medical use would be legalized, with legal protections for patients and physicians.
Read More

New York Enacts Mental Injury Presumption for All Workers

All workers will now have the right to file a claim for mental injuries, based upon extraordinary work-related stress incurred on the job.
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Texas Considers Making Infertility an Occupational Illness for First Responders

A proposed bill would apply to male and female reproductive systems for firefighters and EMTs.
Read More

The Most Engaging RxInformer Articles from 2024

We checked the stats and reviewed our readers’ favorite articles from RxInformer magazine to bring you a list of our most engaging content from 2024.
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Think Globally, Act Locally: Advocating for Administrative Simplification

Collaboration between national and regionally based stakeholders is one way to work towards improving the workers’ compensation system.
Read More
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