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

Mental Health Presumptions

Tennessee Expands PTSD Benefits for First Responders

Law enforcement officers and emergency medical responders will receive the same benefits previously granted to fire fighters.

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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

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

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

Claim Costs Industry Data

WCRI Publishes Medical Price Index

The study compares prices paid for medical services across 36 states from 2008 to 2024, representing 88% of workers’ comp benefits in the U.S.

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May 27, 2025

Advocacy Opportunity Cost Containment Treatment Guidelines

Tennessee Medical Advisory Committee Meeting Highlights

Topics addressed included changes to the fee schedule, utilization review, spinal therapy guidelines, and more.

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May 27, 2025

Technology

Maryland Enacts AI Bill for Health Insurance Utilization

The law requires carriers, pharmacy benefit managers, and private review agents to ensure AI decisions are based on an individual's clinical information.

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May 27, 2025

Access to Care

Colorado Provider Choice Bill Reaches Governor

If enacted, injured workers may choose from any level I or level II accredited physician through the division of workers' compensation.

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May 27, 2025

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Further resources you may be interested in

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

The Cannabis Question: Marijuana and Workplace Safety?

With greater legalization and public approval, the question of safety grows more important.

Changing Workforce, Claims Automation and Tech Connectivity Among Top Priorities in 2022 Industry Survey

The priorities and challenges revealed in our 2022 Workers’ Compensation Industry Insights Survey Report reflect an industry focused on moving forward.