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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Access to Care Cost Containment

Connecticut Adjusts Process to Update Fee Schedules

Effective July 1st, fee schedule adjustments can be made by the Workers’ Compensation Commission without revenue neutrality.

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June 30, 2025

Access to Care Ancillary Services

Oregon Expands Waiver Enforcement for Sign Language Interpreters

The extension will allow sign language interpreters with temporary licenses to continue providing services through June 30, 2026.

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June 30, 2025

Industry Data

Oregon Publishes Biennial Premium Rate Comparison Study

The study focuses on Oregon’s 50 largest industry classes, comparing data to every other state in the country.

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June 30, 2025

Technology

WCRI Publishes Overview of AI Promises and Challenges

The study is based on an exploration of literature and interviews with 34 leaders across workers’ comp.

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June 30, 2025

Access to Care

New York Clarifies When Injured Workers Can Use Out of Network Pharmacies

Effective July 11th, the updated rules apply to controverted claims and other dispute conditions.

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June 16, 2025

Cost Containment Treatment Guidelines

Nevada Enacts Formulary and Changes for Provider Panels

The DIR must adopt the ODG formulary by July 1, 2027.

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June 16, 2025

Advocacy Opportunity Cost Containment Treatment Guidelines

Arizona Commission Discusses Trends and Solutions for Topical Prescriptions

Fee schedule clarity and defined reimbursement caps were discussed as ways to reduce ambiguity and prevent payment disputes.

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June 16, 2025

Ancillary Services Cost Containment

CMS Publishes 2025 Q3 Updates to NCCI Edits

Medically unlikely edits were updated across DME, outpatient hospital services, and more.

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June 9, 2025

Advocacy Opportunity Cost Containment Treatment Guidelines

Arizona Seeks Stakeholder Input on Prescription Topicals

The meeting will take place on June 12th, aiming to explore current trends, challenges, and proposed solutions related to these drugs.

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June 9, 2025

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Further resources you may be interested in

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

More States Continue with PTSD Legislation

Oklahoma and Rhode Island enact new presumptions, with Georgia adding extra coverage.

Maryland and Arizona Enact New Psychedelic Laws

A Maryland taskforce will plan regulation, while Arizona will tentatively cover MDMA treatment for first responders with PTSD.

Positive Marijuana Screenings Increase – What More to Expect with Rescheduling?

New data from Quest Diagnostics 2024 Drug Testing Index, and industry leaders discuss how rescheduling will impact workers’ comp.

Physician Dispensing Concerns in Workers’ Compensation

Physician dispensing represents an ongoing challenge for today’s workers’ comp payers – not only from a cost perspective, but from clinical and safety perspectives.