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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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Texas Issues Data Call

The call focuses on annual experience and workers’ comp deductible plans for the period of January 1, 2025, through December 31, 2025.
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November 17, 2025

Wisconsin Introduces Significant Reform Bill

Assembly Bill 651 could impact benefits levels, PTSD presumptions, penalties, and more
Read More →
November 17, 2025

New Mexico Revises Rules for Fee Schedule Changes

Effective January 1st, CARC and RARC codes will be permitted for use in EOBs, leveraging nationally recognized standards.
Read More →
November 17, 2025

Massachusetts Advisory Council Discusses Medical Fee Schedule

The fee schedule has not been updated since 2009, resulting in low reimbursement rates, which has impacted access to care.
Read More →
November 17, 2025

CMS Finalizes 2026 Medicare Physician Fee Schedule

States that base their workers’ comp fee schedules on the CMS Fee Schedule may adopt these adjustments, which go into effect January 1st.
Read More →
November 17, 2025

White House Announces Deal to Expand Access to GLP-1 Medications

Qualifying CMS patients could face a co-pay of $50 a month for these highly popular drugs for obesity and diabetes.
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November 10, 2025

NCCI Reports on Medical Inflation Insights

Headline inflation rose 3% year over year in September, still above the Federal Reserve’s 2% target but well below 2022 levels.
Read More →
November 10, 2025

NCCI Reports on the Latest Trends in Medical Equipment Cost Share

Average medical equipment costs increased 87% from 2012-2024, with medical equipment representing 8.3% of total workers’ comp medical spend.
Read More →
November 10, 2025

Nevada Publishes FAQ for Upcoming Procedural Reforms

Among many things, the FAQ discusses processes for formulary changes, administrative fines, and provider lists.
Read More →
November 10, 2025
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 Further resources you may be interested in

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

Tracking Sub-Regulatory Changes in Workers’ Comp

Healthe’s VP of Industry and State Affairs, Sandy Shtab, shares her thoughts with Risk & Insurance magazine in a recent article.
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FDA Orders Opioid Manufacturers to Update Prescribing Information for Long-Term Use

All opioid manufacturers must update their drug labeling to align with a list of notes provided by the FDA.
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Burden of Proof: Unpacking Presumptions in Workers’ Comp

Exploring the expansion of presumptions in PTSD, cancers, and more.
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FDA Takes Steps to Restrict Certain Kratom Products

The FDA recommended concentrated 7-OH kratom products to be rescheduled under the Controlled Substances Act.
Read More

The Emerging Role of AI in Workers’ Comp – and the Regulations Surrounding It

An expert Q&A with Sandy Shtab, VP of Industry and State Affairs, on AI in workers’ comp and the regulations surrounding it.
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Nevada Enacts Workers’ Comp Formulary

The state will adopt the ODG Drug Formulary by July 1, 2027, with coverage of non-formulary drugs allowed through January 1, 2028.
Read More
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