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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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

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

Claim Costs Industry Data Worker Safety

CWCI Publishes Report on Long-COVID

Long COVID cases made up 4.7% of COVID claims, totaling 6,000 claims, yet medical payments for long COVID claims was $105 million.

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June 9, 2025

Access to Care

Colorado Injured Workers Can Now Choose Any Treating Provider

Injured workers may now choose any Level I or II accredited physician licensed under the Colorado Medical Practice Act.

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June 9, 2025

Technology Treatment Guidelines

Connecticut, Nebraska, Nevada, and Texas Introduce AI Regulation Bills

These different bills would prevent AI from denying, delaying, modifying, or making clinical decisions in healthcare.

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June 9, 2025

Claim Costs Industry Data Pharmacy Data

Texas Publishes 2024 Health Care Cost and Utilization Report

Pharmacy service costs fell 40% - or $28 million dollars – from 2018 through 2023.

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June 9, 2025

Worker Safety

Arizona Issues Executive Order for Workplace Heat Safety Task Force

The taskforce will have until December 31, 2025 to issue employer guidelines.

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June 2, 2025

Ancillary Services

Colorado Discusses Interpreter Reimbursement at Stakeholder Meeting

The cost of interpreter services now surpasses prescription drug expenses, which has sparked much concern across different stakeholders.

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June 2, 2025

Access to Care

Delaware Proposes 3% Fee Schedule Increase for E&M Services

Supporters of the bill believe it will alleviate a shortage of physicians willing to accept workers’ comp patients.

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June 2, 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.