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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 Treatment Guidelines

Nevada Enacts Formulary and Changes for Provider Panels

The DIR must adopt the ODG formulary by July 1, 2027.

June 16, 2025

New York Clarifies When Injured Workers Can Use Out of Network Pharmacies

Effective July 11th, the updated rules apply to controverted claims and other dispute conditions.

June 16, 2025

Claim Costs Industry Data Pharmacy Data

Texas Publishes 2024 Health Care Cost and Utilization Report

Pharmacy service costs fell 40% - or $28 million dollars – from 2018 through 2023.

June 9, 2025

Technology Treatment Guidelines

Connecticut, Nebraska, Nevada, and Texas Introduce AI Regulation Bills

These different bills would prevent AI from denying, delaying, modifying, or making clinical decisions in healthcare.

June 9, 2025

Colorado Injured Workers Can Now Choose Any Treating Provider

Injured workers may now choose any Level I or II accredited physician licensed under the Colorado Medical Practice Act.

June 9, 2025

Claim Costs Industry Data Worker Safety

CWCI Publishes Report on Long-COVID

Long COVID cases made up 4.7% of COVID claims, totaling 6,000 claims, yet medical payments for long COVID claims was $105 million.

June 9, 2025

Advocacy Opportunity Cost Containment Treatment Guidelines

Arizona Seeks Stakeholder Input on Prescription Topicals

The meeting will take place on June 12th, aiming to explore current trends, challenges, and proposed solutions related to these drugs.

June 9, 2025

Ancillary Services Cost Containment

CMS Publishes 2025 Q3 Updates to NCCI Edits

Medically unlikely edits were updated across DME, outpatient hospital services, and more.

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.

June 2, 2025

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Further resources you may be interested in

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

FDA Revokes Emergency Use Authorization for Bamlanivimab for COVID-19

Due to mutating viral strains, the potential benefits of this COVID-19 drug no longer outweigh the risks.

Department of Labor Hints at Changes to Worker Classification

While many states are making decisions regarding gig workers, federal action could soon change things.

A Brighter Tomorrow? Applying Pandemic Lessons Today

A message from the Chief Executive Officer

Making Telemedicine Work for Workers’ Comp

The future of telemedicine and practical tips to make it effective in workers' comp

Infographic: Uncommon Ground

See how perceptions of workers' comp pros and injured workers don't always align

State of the States

A roundup of regulatory activity around the country

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