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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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Louisiana Bill Would Remove Prescription Drugs from MTS Authorization and Appeals

Louisiana introduced a bill that would remove prescribed drugs from the Medical Treatment Schedule (MTS) authorization timelines and Medical Director appeal process under the workers’ compensation law.
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April 6, 2026

West Virginia PBM Bill Bans Spread Pricing

A new West Virginia PBM bill, effective immediately, prohibits spread pricing and requires PBM fees to be transparent and independent of drug cost.
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April 6, 2026

Wisconsin Agreed Bill Expands PTSD Eligibility

On March 31, Wisconsin passed a bill expanding PTSD‑only workers’ compensation claim eligibility for certain first responders and adopting a broader package of agreed‑upon reforms.
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April 6, 2026

WCRI Study Finds Provider Networks Improve Claim Outcomes

A new study from the Workers Compensation Research Institute found that injured workers treated in medical provider networks have lower medical and total claim costs, faster access to care, and improved disability outcomes.
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April 6, 2026

NCCI Highlights 2026 Legislative and Regulatory Trends

NCCI’s 2026 Emerging Legislative and Regulatory Issues report identifies heat exposure, workplace violence, and broader workers’ compensation system changes as key areas impacting workers’ compensation programs.
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April 6, 2026

Louisiana Bill Would Modify Key Parts of State’s Workers’ Compensation System

On March 31, Louisiana introduced a bill that would change how Medical Maximum Improvement (MMI) is defined and how wage-loss benefits are paid.
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April 6, 2026

Oklahoma Bills Would Create Conflicts for Workers’ Compensation Pharmacy

Two Oklahoma bills heading for House consideration would establish a NADAC based reimbursement floor, minimum dispensing fees, and a shortened 30 day payment timeframe.
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March 30, 2026

DME Vendors Are Not “Providers” Under Pennsylvania Workers’ Comp Law

A Pennsylvania appellate court ruled that a distributor of Durable Medical Equipment (DME) does not qualify as a “healthcare provider” under the Workers’ Compensation Act and therefore cannot use the state’s medical fee review process to dispute reimbursement.
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March 30, 2026

New York Proposes Regulations Expanding Pay Without Prejudice Rules for Medical Payments

The New York Workers’ Compensation Board has proposed rules allowing carriers to temporarily pay for medical treatment while compensability is under review, without admitting liability.
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March 30, 2026
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 Further resources you may be interested in

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

Pain Points: Chronic Pain and the Injured Worker

Chronic pain affects millions and has direct consequences for injured workers and in the workplace, from absenteeism to higher healthcare costs.
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State of the Nation

A perspective penned by our VP of Industry and State Affairs
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Digital Therapeutics: The Promise of Better Health Outcomes for Injured Workers

What they are, the benefits, how they’re currently covered by insurers, and future outlooks.
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Massachusetts Considers Reimbursement, California Could Reject Medical Recommendation

A bill in Massachusetts could require insurers to pay for marijuana, while ACOEM recommends against marijuana for chronic pain guidelines.
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Visit Healthesystems at RISKWORLD 2025

Drop by Booth #824 for a copy of the 15th Anniversary edition of RxInformer magazine, and to learn how we’re transforming healthcare.
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PTSD Presumptions Continue to See Activity

New York backpedaled on a PTSD presumption for all workers, while California considers a PTSD presumption for healthcare workers.
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