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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Claim Costs Industry Data

Minnesota Publishes Workers’ Comp System Trends Report

The report covers trends from 2003 to 2023, looking at claim frequency and costs, vocational rehab, dispute resolutions, and more.

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July 28, 2025

Claim Costs

California Increases Advisory Pure Premium Rate

An 8.7% increase will take effect on September 1, 2025, slightly below the WCIRB’s suggested 11.2% increase.

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July 28, 2025

Advocacy Opportunity Cost Containment

CMS Proposes Update to Physician Fee Schedule

The proposed changes would impact reimbursement rates, telehealth services, and much more.

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July 21, 2025

Access to Care Mental Health

West Virginia Will Allow Mental Health Nurse Practitioners to Diagnose PTSD

These practitioners must hold a master’s degree and a terminal license within their profession.

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July 21, 2025

Advocacy Opportunity Claim Costs Industry Data

Texas DWC Quarterly Insurance Carrier Meeting Highlights

The meeting covered 2024 healthcare costs and utilization, along with incoming regulatory changes.

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July 21, 2025

Advocacy Opportunity Cost Containment Treatment Guidelines

Michigan Advisory Council Discusses 2026 Ruleset

The meeting covered fee schedule policies impacting physician-dispensed medication, electronic delivery for EOBs, and more.

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July 21, 2025

Advocacy Opportunity Cost Containment Treatment Guidelines

California P&T Committee Reviews Topical Analgesics

The next meeting in October will deliver an expanded formulary list, with a review of the top five to ten exempt drugs based on utilization.

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July 21, 2025

Industry Data

WCRI Reports on High-Cost Claims with Rotator Cuff Disorders

In rotator cuff claims exceeding $65,000 in costs within 36 months of injury, surgery was present 85% of the time.

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July 14, 2025

Claim Costs Industry Data

WCRI Publishes Report on Post-Inflation Trends in Medical Payments

From 2021 to 2024, medical payments per claim increased by about 5% per year in most states, rebounding from earlier pandemic-related declines.

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July 14, 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.