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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Billing & Payments

West Virginia PBM Bill Bans Spread Pricing

A new West Virginia PBM bill, effective immediately, prohibits spread pricing and requires PBM fees to be transparent and independent of drug cost.

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April 6, 2026

Mental Health Presumptions

Wisconsin Agreed Bill Expands PTSD Eligibility

On March 31, Wisconsin passed a bill expanding PTSD‑only workers’ compensation claim eligibility for certain first responders and adopting a broader package of agreed‑upon reforms.

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April 6, 2026

Access to Care Claim Costs Industry Data

WCRI Study Finds Provider Networks Improve Claim Outcomes

A new study from the Workers Compensation Research Institute found that injured workers treated in medical provider networks have lower medical and total claim costs, faster access to care, and improved disability outcomes.

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April 6, 2026

Industry Data Worker Safety

NCCI Highlights 2026 Legislative and Regulatory Trends

NCCI’s 2026 Emerging Legislative and Regulatory Issues report identifies heat exposure, workplace violence, and broader workers’ compensation system changes as key areas impacting workers’ compensation programs.

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April 6, 2026

Billing & Payments

Louisiana Bill Would Modify Key Parts of State’s Workers’ Compensation System

On March 31, Louisiana introduced a bill that would change how Medical Maximum Improvement (MMI) is defined and how wage-loss benefits are paid.

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April 6, 2026

Advocacy Opportunity Billing & Payments

Oklahoma Bills Would Create Conflicts for Workers’ Compensation Pharmacy

Two Oklahoma bills heading for House consideration would establish a NADAC based reimbursement floor, minimum dispensing fees, and a shortened 30 day payment timeframe.

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March 30, 2026

Ancillary Services Billing & Payments

DME Vendors Are Not “Providers” Under Pennsylvania Workers’ Comp Law

A Pennsylvania appellate court ruled that a distributor of Durable Medical Equipment (DME) does not qualify as a “healthcare provider” under the Workers’ Compensation Act and therefore cannot use the state’s medical fee review process to dispute reimbursement.

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March 30, 2026

Billing & Payments

New York Proposes Regulations Expanding Pay Without Prejudice Rules for Medical Payments

The New York Workers’ Compensation Board has proposed rules allowing carriers to temporarily pay for medical treatment while compensability is under review, without admitting liability.

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March 30, 2026

Billing & Payments Cost Containment

Colorado Will Host Fee Schedule Listening Session

The Colorado Division of Workers’ Compensation (DOWC) will host a listening session on April 9, 2026 at 4:00 p.m. MT to gather feedback from employers, insurers, providers, and other workers’ compensation stakeholders on Rule 18 (Medical Fee Schedule).

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March 30, 2026

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Further resources you may be interested in

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

INFOGRAPHIC: Current State of Complex Claims in Workers’ Comp

Statistics from recent studies across the industry shed light on complex claims in workers' compensation.

State of the Nation

Sandy Shtab, VP of Industry and State Affairs, shares policy perspectives.

Cannabis Drug Beats Opioids in Phase 3 Low Back Pain Trial

VER-01, a cannabis extract, outperformed both placebo and opioids in two late-stage clinical trials.

NCCI Publishes 2025 Regulatory and Legislative Trends Report

NCCI tracked 950 bills impacting workers’ comp, highlighting key trends across the country, such as PTSD and cancer presumptions, worker classification, and psychedelics.