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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.

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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.

Cost Containment

Ohio Withdraws Outpatient Medication Reimbursement Rules

Filed in October 2024, the amendments aimed to adjust AWP discount rates and standardize dispensing fees.

April 14, 2025

Treatment Guidelines

Nevada Now Considering Evidence-Based Formulary After Bill Hearing

Senate Bill 317 originally focused on provider panels, but a recent hearing amended the bill to include a workers’ comp formulary.

April 14, 2025

Cost Containment

Louisiana Proposes a Workers’ Comp Fee Schedule

The bill could require biennial updates, utilizing RVUs form the resource-based relative value scale (RBRVS).

April 14, 2025

California Releases Report on Independent Medical Reviews

A total of 199,651 IMR applications were received in 2024, with pharmaceuticals making up 32.7%.

April 14, 2025

Advocacy Opportunity Cost Containment Treatment Guidelines

California P&T Committee to Meet on April 16th

The hybrid meeting will cover the pharmacy fee schedule, biosimilars, cannabis coverage, and payments for topical drugs.

April 14, 2025

Psilocybin Bills Enacted in Colorado and North Dakota

Colorado’s bill allows for prescription of psilocybin upon an FDA-approved product, while North Dakota lists psilocybin as a Schedule IV drug.

April 7, 2025

Montana Could Recognize Physical Therapists as Treating Physicians

Passing both chambers nearly unanimously, Senate Bill 109 currently sits with the governor.

April 7, 2025

Billing & Payments

Florida Discusses Provider Reimbursement at Stakeholder Meeting

Healthesystems attended the meeting to capture key discussion updates.

April 7, 2025

Mental Health Presumptions

Connecticut Proposes Expansion to PTSD Presumption

A new qualifying event would include witnessing a serious physical injury that does not result in death or permanent disfigurement.

April 7, 2025

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Further resources you may be interested in

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

State of the States

A roundup of regulatory activity around the country

Classification Complications: Will Gig Workers Enter the Workers’ Comp Market?

Legislation could potentially reclassify gig workers as employees entitled to workers’ comp.

Marijuana: States Move Forward Medically and Recreationally, But Oppose Reimbursement in Comp

Since the start of 2022, at least 10 states are considering some form of marijuana legislation.

CDC Updates Isolation and Quarantine Period for COVID-19

New five-day rules are recommended, with variation depending upon vaccination status.

Federal Judges Try to Block Vaccine Mandates

Rulings from U.S. District Courts have impeded vaccine requirements among certain workers.

Cannabis in the Workplace on the Rise

One-third of employees have witnessed cannabis use during work hours.

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Workers' Comp Property and Casualty PBM
Expires 01/01/2028