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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Cost Containment

Connecticut Reduces Drug Reimbursement Rates

Updates to the Practitioner Fee Schedule switch from an AWP-plus reimbursement model to an AWP-discount model.

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July 20, 2026

California P&T Committee Reviews Rising Drug Costs and Utilization Patterns

The Committee is focused on high-cost and high-utilization medications, including GLP-1s, PPIs, anticonvulsants, topical agents, and biologics.

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July 20, 2026

Advocacy Opportunity Cost Containment Treatment Guidelines

Florida’s Physician Dispensing Rules Continue to Be Evaluated

Commenters asked the DWC to clarify the scope of pharmacy and pharmacist definitions and prior authorization requirements.

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July 20, 2026

Access to Care Technology

SAWCA Convention Recap

Access to care and AI emerged as dominant themes of the conference.

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July 20, 2026

Presumptions

Alaska Revises Cancer Presumption for Firefighters

While cancer coverage remains the same, timelines and qualifications for coverage have been adjusted.

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July 20, 2026

Advocacy Opportunity Treatment Guidelines

Texas Proposes Updates to Impairment Rating Guidelines

The Fourth Edition of the AMA Guidelines have been in use since 2000 and would be updated to the Six Edition, published 2025.

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July 20, 2026

Ancillary Services

CMS Proposes Updates to Expand Access to Home Healthcare

The proposed rule includes an estimated 2.4% increase in Medicare payments to home health agencies to support access to care.

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July 13, 2026

Billing & Payments Claims Procedures

Florida Extends Deadlines for Medical Reimbursement Disputes

Providers now have 60 days to petition the DWC when carriers adjust or disallow payment, while carriers have 45 days to respond to petitions.

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July 13, 2026

Worker Safety

Colorado Enacts Extreme Temperature Protections

Extreme heat and cold protections originally created for agricultural workers have now been extended to all employees.

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July 13, 2026

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Further resources you may be interested in

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

States Seek to Limit AI-Generated Care Decisions, Despite White House Order

Legislators continue to introduce bills to limit AI-generated healthcare decisions, even as the U.S. Attorney General has been instructed to oppose them.

White House Issues Executive Order to Reschedule Marijuana

Rescheduling marijuana to Schedule III will allow for greater clinical research, possible FDA-approved drugs, and more.

States Consider Expanding Presumptions

So far in 2026, eight states and counting are seeking to expand existing presumptions or create new presumptions.

Could AI-Designed Drugs Impact Regulatory Frameworks?

While AI can be effective in some elements of drug design, AI models currently struggle to explain their decision making, a key component of drug review.