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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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CMS Publishes 2025 Q1 Updates to NCCI Edits

Changes will impact DME supplier services, facility outpatient hospital services, and practitioner services.
Read More →
December 9, 2024

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.
Read More →
December 9, 2024

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.
Read More →
December 9, 2024

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.
Read More →
December 9, 2024

New Mexico Workers’ Compensation Administration Publishes Annual Report

Claim frequency has trended down since 2019, with medical-only claims fluctuating and average per-claim costs peaking at $8,817 in 2022.
Read More →
December 9, 2024

Illinois Proposes AI Regulations for Health Insurers

House Bill 5918 would prohibit using AI or predictive models as the sole basis for denying, reducing, or terminating coverage.
Read More →
December 9, 2024

NCCI Publishes Injury Characteristics and Insights Dashboard

The dashboard examines data on cause of injury, nature of injury, body part grouping, and injury severity rankings.
Read More →
December 3, 2024

Texas Bill Could Make Infertility an Occupational Illness for First Responders

Senate Bill 454 proposes an infertility presumption for firefighters and EMTs for male and female reproductive systems.
Read More →
December 3, 2024

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.
Read More →
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.

Texas Reminds Providers Certain Exams Must Be Done in Person

Maximum medical improvement (MME) and impairment rating (IR) evaluations cannot be done remotely.
Read More

Remdesivir a Potential Treatment for COVID-19?

The FDA allows emergency use in response to positive trials, but more research is needed.
Read More

State of the States

A roundup of regulatory activity around the country
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IQVIA Reports on Healthcare Shifts in the COVID-19 Era

A new study explores patients’ use of health services, the impact on medicine use, research activity, and more.
Read More

California Executive Order Greatly Expands COVID-19 Presumption

Many states expanded workers’ comp for COVID-19, but California casts a wider net.
Read More

By the Numbers: Covid-19 Edition

A collection of facts and figures surrounding the COVID-19 pandemic
Read More
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