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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Presumptions

Michigan Considers Infectious Disease Presumption for Essential Workers

The bill would apply to those required to work during a state of emergency to protect life or maintain critical operations.

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November 10, 2025

Access to Care Billing & Payments Claims Procedures

Michigan Introduces Bill to Strengthen Injured Worker Protections

The bill impacts required medical services, provider choice, preauthorization requests, and more.

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November 10, 2025

Industry Data

NCCI Reports on Remote Work and Workers’ Comp Frequency

According to the NCCI, remote work makes up 20–30% of the U.S. workforce, up from 4–7% pre-pandemic.

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November 3, 2025

Billing & Payments Industry Data

Texas Releases 2026 Performance Based Oversight Assessment Plan

The assessment will be based on five key metrics of medical data reported to the DWC from January 1st to June 30th of 2026.

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November 3, 2025

Advocacy Opportunity Claim Data Cost Containment

South Dakota Reports on Fee Schedule and Medical Trends

2025 relative values for physicians will be incorporated, while NCCI medical data was reviewed to compare state trends to national trends.

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November 3, 2025

Access to Care Claims Procedures

Nevada Clarifies Provider Choice Requirements for First Responders

Since October 1st, first responders have been able to select their own physician for heart and lung claims under certain conditions.

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November 3, 2025

Access to Care Claims Procedures

Maryland Urges Accommodations for Policyholders Affected by Government Shutdown

Proposed accommodations include deferring premium payments, extending grace periods, and waiving late fees and penalties.

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October 27, 2025

Claims Procedures

California: New Standards for Third Party Settlements

Effective January 1, 2026, this new law applies to injured peace officers and firefighters.

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October 27, 2025

Billing & Payments Industry Data

California Publishes 2026 Audit Standards for Claims Administrators

The audits will assess compliance with workers’ comp laws, focusing on timely and accurate payments and proper issuance of medical evaluation notices.

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October 27, 2025

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Further resources you may be interested in

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

Drug Pricing Legislation and Its Impact on Workers' Comp

Lawmakers look to regulate the U.S. drug supply chain in ways that could impact workers’ comp pharmacy management.

High Prices, High Impact: Meet the Drugs Driving Up Claim Costs in Workers’ Comp

High-impact drugs, including topicals and compounds, represent proportionately low utilization compared to opioids or NSAIDs, but they can increase pharmacy spend exponentially on impacted claims.