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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.

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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Ohio Delays Pharmacy Reimbursement Rulemaking to Allow for Stakeholder Input

The Bureau of Workers’ Compensation will take additional time to address stakeholder concerns and make necessary revisions.
Read More →
December 16, 2024

South Carolina Considers Mental Injury Presumption for First Responders

Law enforcement officers and firefighters employed by state or local governments could receive workers’ comp benefits if they experience a qualifying traumatic experience.
Read More →
December 16, 2024

New York Rejects Pharmacy Network Bill

The bill would have allowed injured workers to fill prescriptions at any pharmacy of their choice, including outside of network pharmacies.
Read More →
December 16, 2024

Illinois Proposes AI Regulations for Health Insurers

House Bill 5918 would prohibit using AI or predictive models as the sole basis for denying, reducing, or terminating coverage.
Read More →
December 9, 2024

New Mexico Workers’ Compensation Administration Publishes Annual Report

Claim frequency has trended down since 2019, with medical-only claims fluctuating and average per-claim costs peaking at $8,817 in 2022.
Read More →
December 9, 2024

New York Governor Vetoes Increase to Prior Authorization Thresholds

The proposed bill would have required prior authorization on treatments above $1,500, instead of $1,000.
Read More →
December 9, 2024

Texas Publishes Biennial Report to the 89th Legislature

Among a wide array of data, pharmacy spend decreased 71% from 2012-2022, with average cost per pharmacy claim dropping 38%, from $908 to $563.
Read More →
December 9, 2024

Wisconsin to Gather Stakeholder Input for Legislative Changes

A public hearing on December 10th will gather stakeholder input, with written comments accepted by January 10, 2025.
Read More →
December 9, 2024

CMS Publishes 2025 Q1 Updates to NCCI Edits

Changes will impact DME supplier services, facility outpatient hospital services, and practitioner services.
Read More →
December 9, 2024
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 Further resources you may be interested in

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

Wisconsin Announces Plan to Lower Prescription Drug Costs

State-led efforts to combat the drug price issue continue to emerge across the nation.
Read More

COVID-19 Mutations Impact Testing

False negatives may be reported due to genetic variations of the virus.
Read More

Worker Classification Debate Continues Across the Country

The Department of Labor issued a new rule while special interest groups push for regulatory change.
Read More

The Department of Justice Sues Walmart Over Role in Opioid Crisis

Alleged violations of the Controlled Substances Act could result in billions of dollars in penalties.
Read More

Top 10 Disruptors of 2020 for the Workers’ Comp Industry

Initial insights from Healthesystems’ annual industry survey.
Read More

FDA Authorizes Two COVID-19 Vaccines, At-Home Test, More Treatments

Vaccine candidates from Pfizer-BioNTech and Moderna received EUAs, as did the first at-home test that delivers results in 30 minutes, and two treatments for the virus.
Read More
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