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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Training Opportunity

Nevada Offers Training Webinar for ODG Formulary

The webinar will take place on November 5th at 11:00 AM PST.

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September 15, 2025

Billing & Payments Cost Containment

California Bill Would Require EORs to Include Contract Information

Provider EORs would require contract-specific info. Not providing a requested contract in 30 days allows bills to be reprocessed at full fee schedule rates.

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September 15, 2025

Access to Care Ancillary Services

Delaware Approves 125% Medicare Reimbursement Rate for E&M Procedures

The adjustment aims to address longstanding underpayment for E&M services, as low reimbursement has contributed to provider shortages.

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September 15, 2025

Industry Data

Study Finds Long COVID Linked to Productivity Loss

Participants who reported ongoing long COVID symptoms were more than three times more likely to report work productivity loss than those without persistent symptoms.

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September 8, 2025

Cost Containment

CMS Publishes 2025 Q4 NCCI Edit Updates

The changes are effective October 1, replacing the 2025 Q3 versions.

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September 8, 2025

Advocacy Opportunity Billing & Payments

Ohio BWC to Refile Outpatient Medication Rules

The BWC withdrew its proposed outpatient medication reimbursement rules for self-insured employer claims due to a technical error.

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September 8, 2025

Cost Containment

NCCI Publishes New Research Brief on Medical Fee Schedules

The report reviews how changes to CMS reimbursement rules may impact medical costs in workers’ comp.

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September 1, 2025

Worker Safety

CPWR Publishes Report on Heat Injuries and Illness Among Construction Workers

While construction workers make up only 7% of the workforce, they account for more than one-third of occupational heat-related deaths in the U.S.

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September 1, 2025

Mental Health Presumptions

New Jersey Now Requires Counseling for First Responders After Traumatic Incidents

Effective immediately, workers’ comp programs are required to pay for up to 12 hours of counseling following critical incidents.

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September 1, 2025

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Further resources you may be interested in

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

Thought Leadership from Healthesystems

A new issue of RxInformer magazine, plus Leaders Speak posts in WorkCompWire, featuring Sandy Shtab and Silvia Sacalis.

Sleep Woes: Fatigue in the Workplace

Sleep deprivation and fatigue have far-reaching consequences in the workplace, from poor productivity to injury or death.

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.