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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.

Hawaii Could Expand Firefighter Cancer Presumption

A proposed bill could add additional types of cancer to the pre-existing presumption for firefighters.

February 9, 2026

Billing & Payments Claim Data Industry Data

California Publishes Independent Billing Review Report

About 6% of medical bills challenged through the dispute process were initially paid correctly.

February 9, 2026

WCRI Reports on Trends in Joint Replacement Surgery

Using data from 2 million claims across 32 states, the study found that the prevalence of these surgeries increased, driven by shoulder joint replacements.

February 9, 2026

Claim Costs Claim Data

NCCI Publishes Report on Fast-and-Slow Emerging Claims

Both claims reach costs of $1 million or more, but at different points in time after injury.

February 9, 2026

Cost Containment Treatment Guidelines

Hawaii Bills Target Pharmacy Management Rules

New bills would address compounds, deadlines for authorization decisions, and more.

February 2, 2026

Cost Containment

Missouri Proposes Fee Schedule

The bill would require a formal fee schedule for all services provided under workers’ comp, taking effect August 28, 2026.

February 2, 2026

Multiple States Seek to Limit AI-Generated Care Decisions

Alabama, Hawaii, Kentucky, Oklahoma, Pennsylvania, and Virginia have all introduced bills to limit AI-generated care decisions.

February 2, 2026

Arizona Could Cover Travel Injuries for Firefighters

Injuries occurring when traveling to and from work would be covered, assuming no criminal activity was undertaken.

February 2, 2026

Mental Health Presumptions

Florida and Vermont Could Extend PTSD Coverage to 911 Dispatchers

Pre-existing PTSD presumptions for first responders could be extended to 911 dispatchers.

February 2, 2026

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Further resources you may be interested in

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

A Hot Topic: The Latest News on Workers and Extreme Heat

Recent data insights, state proposals, and updates on federal rulemaking procedures.

FDA Issues Draft Guidance for the Use of AI in the Creation of Drugs and Medical Devices

The guidelines provide recommendations on using AI to demonstrate drug safety and effectiveness, and recommendations for AI-enabled medical devices.

California Updates Pharmacy Fee Schedule

Among many changes, the state is replacing AWP with a new pricing model.

Missouri Proposes Bill for Psilocybin Therapy

Medical use would be legalized, with legal protections for patients and physicians.

New York Enacts Mental Injury Presumption for All Workers

All workers will now have the right to file a claim for mental injuries, based upon extraordinary work-related stress incurred on the job.

Texas Considers Making Infertility an Occupational Illness for First Responders

A proposed bill would apply to male and female reproductive systems for firefighters and EMTs.

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Workers' Comp Property and Casualty PBM
Expires 01/01/2028