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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.

Mental Health Presumptions

Presumption Bills Continue to Trend

Arizona proposes a PTSD presumption, while Maryland proposes a hypertension presumption.

January 19, 2026

New Bills Propose Workers’ Comp Changes Related to Immigration Status

New bills in Florida and New Jersey could affect workers’ comp coverage for undocumented workers.

January 19, 2026

Claim Data Pharmacy Data

WCRI Publishes Report on Injectable Therapies

The report classifies distinct subgroups of injectable by medication type and identifies those most common in workers’ comp.

January 19, 2026

New Jersey Proposes Comp Exclusion for Intoxication

Intoxication as a material contributing factor to injury or death could disqualify individuals for benefits.

January 19, 2026

Advocacy Opportunity Industry Data Pharmacy Data

Texas Publishes Audit Report for Gabapentin and Pregabalin Prescribing

The report includes recommendations for providers, and the findings could impact rules around prescribing, utilization review, and service delivery.

January 12, 2026

Advocacy Opportunity Billing & Payments

New York Proposes Billing Guidelines for Residents and Fellows

After expanding access to care by allowing these providers to treat injured workers, billing guidelines for these providers are being developed.

January 12, 2026

Advocacy Opportunity Ancillary Services

Ohio Proposes Rule Changes for Prosthetic Coverage

Under the proposal, the BWC would cover purchases through their surplus fund if the need stems from an allowed injury or occupational disease.

January 12, 2026

Florida May Increase Cancer Benefits to Firefighters With $25,000 Payment

Additionally, benefits may be extended for up to 10 years post-employment.

January 12, 2026

Mental Health Presumptions

Kentucky Could Make Psychological Injuries Compensable for First Responders

If enacted, House Bill 26 would apply to police officers, firefighters, emergency medical services personnel, and members of the National Guard.

January 12, 2026

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Further resources you may be interested in

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

2025 Workers’ Comp Industry Insights Survey Report

The seventh annual survey report highlights the top challenges and priorities for 515 industry stakeholders.

Flurry of States Eye Updates for Cancer and PTSD Presumptions

Various states are proposing modifications to existing presumptions to expand coverage for first responders.

A Hot Topic: The Latest News on Workers and Extreme Heat

Recent data insights, state proposals, and updates on federal rulemaking procedures.

FDA Issues Draft Guidance for the Use of AI in the Creation of Drugs and Medical Devices

The guidelines provide recommendations on using AI to demonstrate drug safety and effectiveness, and recommendations for AI-enabled medical devices.

California Updates Pharmacy Fee Schedule

Among many changes, the state is replacing AWP with a new pricing model.

Missouri Proposes Bill for Psilocybin Therapy

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

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