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 Treatment Guidelines

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.

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December 9, 2024

Industry Data

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.

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December 9, 2024

Advocacy Opportunity

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.

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December 9, 2024

Cost Containment

CMS Publishes 2025 Q1 Updates to NCCI Edits

Changes will impact DME supplier services, facility outpatient hospital services, and practitioner services.

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December 9, 2024

Advocacy Opportunity Telehealth

Texas Seeks Input on Telemedicine Expansion for MMI Certifications

Stakeholders can email written comments to the DWC until January 13, 2025.

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December 9, 2024

Cost Containment

California Reports on Inflation’s Impact on State Fee Schedule

The CWCI notes that cumulative percent increases to the Official Medical Fee Schedule have been lower than economy-wide inflation.

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December 3, 2024

Worker Safety

Nevada Enacts Worker Heat Protections

Businesses with more than 10 employees will be required to follow these regulations, 90 days after the filing date of November 15th.

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December 3, 2024

Worker Safety

New Jersey Proposes Heat Protection Bills

Two identical bills were introduced to the Assembly and Senate, which would define excessive heat as 85 degrees or higher, with provisions for working in excessive heat.

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December 3, 2024

Technology

Oklahoma Issues Bulletin on Ethical AI Use in Insurance

While the bulletin outlines ways carriers can demonstrate compliance with state laws, it does not mandate specific practices or documentation.

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December 3, 2024

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Further resources you may be interested in

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

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

The pandemic has disrupted access to care, but the industry has implemented reactive measures

Returning to Work in the COVID-19 Era

Considerations for infection prevention, unique population factors, and more

Moving Forward: How Should Opioid Guidance Continue to Evolve?

Opioid use has decreased, prompting calls for reform, but COVID-19 complicates opioid use

COVID-19 Infection Risks and Mental Health Impact Among Grocery Workers

Direct customer exposure is associated with a five-fold risk of infection, while less social distancing in the workplace is tied to depression and anxiety.