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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Claim Data Industry Data

NCCI Reports on Interstate Regional Cost Differences

The report provides a collection of actuarial metrics across three of the NCCI’s largest jurisdictions by population – Florida, Illinois, and Texas.

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December 15, 2025

Access to Care Claims Procedures

Indiana and Washington Introduce Provider Choice Bills

If enacted, Indiana House Bill 1069 would go into effect July 1, 2026, while Washington Senate Bill 5847 would go into effect June 30, 2027.

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December 15, 2025

Access to Care Claims Procedures

New York Pharmacy Network Bill Vetoed by Governor

The bill would have duplicated existing protections for filling certain prescription out-of-network.

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December 8, 2025

Access to Care

Expanding Access to Care Across the Country

Delaware reported success with a recent bill, while Washington State is undergoing rulemaking and the U.S. Senate introduced a new bill.

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December 8, 2025

Billing & Payments Cost Containment

Pennsylvania Supreme Court Reviews Drug Pricing Case

The case will examine the Bureau of Workers’ Compensation’s use of RED BOOK for calculating AWP.

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December 8, 2025

Cost Containment

CMS Publishes 2026 Q1 NCCI Edits

Changes will impact DME supplier services, facility outpatient hospital services, and practitioner services.

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December 8, 2025

Claim Data

Delaware and Pennsylvania Expand Medical Data Call Reporting

Insurers with 0.25% of market share must begin sharing data by July 1, 2026, while those with lower market share must begin by January 1, 2027.

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December 8, 2025

Advocacy Opportunity Ancillary Services Claims Procedures

Nevada Schedules Workshop to Review Reform Rule Changes

This workshop will cover rules around panel provider lists, delegating follow-up care to physician assistants, and other clerical matters.

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December 8, 2025

Industry Data

Texas Finalizes Designated Doctor Plan-Based Audit

The audit will evaluate the medical necessity and reasonableness of referrals and diagnostic testing ordered by designated doctors.

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November 24, 2025

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Further resources you may be interested in

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

Congressional Budget Bill Could Place 10-Year Ban on State AI Regulations

If passed, the bill would prevent the enforcement of laws on AI models and automated decision systems.

Then and Now: 8 Reflections from 15 Years of RxInformer

In celebration of the 15 year anniversary of RxInformer, the editorial staff looked back at past issues to understand what has changed – and what hasn’t.

WCRI Reports on the Impact of Marijuana Laws on Workers’ Comp Benefits

While recreational marijuana laws may be tied to increases in claim frequency, medical payments and prescriptions decreased, including those for opioids.