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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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

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

Mental Health Presumptions

New Jersey May Require Counseling for First Responders After Traumatic Incidents

Up to 12 hours of counseling must be provided by workers’ comp – with up to 24 hours more if a mental health professional finds it necessary.

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July 14, 2025

Mental Health Presumptions

Maine Indefinitely Extends PTSD Presumption for First Responders

Set to expire on October 30th, the state’s PTSD presumption no longer faces an expiration date.

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July 14, 2025

Presumptions

California Proposes Multiple New Presumptions for Hospital Workers

Senate Bill 632 would grant these workers presumptions for musculoskeletal injuries, COVID-19, respiratory disease, cancer, and PTSD.

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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.

State of the States

Sandy Shtab, Healthesystems AVP of Advocacy and Compliance, comments on regulatory activity across the country.

Side Effects: COVID-19-Related Healthcare and Pharmacy Trends Impacting Workers' Comp

The COVID-19 pandemic has had a profound impact on the American healthcare system, causing disruptions and driving rapid adaptations to care delivery.