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

New York Expands Provider Access and Raises Authorization Threshold

Any licensed healthcare provider in good standing may treat injured workers, and prior auth thresholds increase from $1,000 to $1,500.

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June 22, 2026

CWCI Report: Increased Use of Unlisted Billing Codes Driving Medical Inflation

Payments for unlisted professional service more than doubled from 2017-2024.

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June 22, 2026

Advocacy Opportunity Cost Containment

Florida Amends Billing Rules After Physician Dispensing Ruling

The proposed rules would align with the February 2026 ruling on physician dispensing in Publix Super Markets, Inc. v. Department of Financial Services.

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June 15, 2026

Marijuana

New Proposal Would Ban Cannabis Coverage in Federal Workers’ Comp Claims

If enacted, the ban would remain in effect regardless of rescheduling.

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June 15, 2026

Claims Procedures Cost Containment

California Proposes Contract-Based Medical Bill Reduction

If enacted, payers must identify a contact person for whom providers could reach for contract-based medical bill information.

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June 15, 2026

Claim Data

California Sees Increase in Cumulative Trauma Claims

Since 2020, total costs for CT claims have more than doubled, with CT claims more likely to involve medical-legal and interpreter services early on.

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June 15, 2026

Cost Containment

Louisiana Transfers Fee Schedule Oversight to OWCA

The Office of Workers’ Compensation Administration (OWCA) must evaluate and update reimbursement rates by July 1, 2029.

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June 15, 2026

Alternate Comp Coverage Presumptions

Louisiana Creates Additional Reimbursement Pathway for First Responders

This would address extraordinary medical or dental expenses not covered by workers’ comp or employer-sponsored health insurance.

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June 15, 2026

Billing & Payments Claims Procedures

Louisiana Establishes Medical Billing Database

The rollout of data collection practices sets the stage for an updated state fee schedule in 2029.

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June 8, 2026

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Further resources you may be interested in

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

Expert Q&A: What Utah’s AI Prescription Renewal Pilot Signals About the Evolving Role of AI in Treatment Decisions

Utah’s prescription renewal pilot is a groundbreaking use case for AI in healthcare. What are the potential benefits and pitfalls?

Inside Medical Experience: Signals, Trends, and System Impact

Healthe’s VP of Industry and State Affairs, Sandy Shtab, joins a panel presentation at the Pennsylvania/Delawaare 2026 Workers’ Compensation Symposium.