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 Costs Industry Data

WCRI Publishes Report on Post-Inflation Trends in Medical Payments

From 2021 to 2024, medical payments per claim increased by about 5% per year in most states, rebounding from earlier pandemic-related declines.

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July 14, 2025

Mental Health Presumptions

New Jersey May Require Counseling for First Responders After Traumatic Incidents

Up to 12 hours of counseling must be provided by workers’ comp – with up to 24 hours more if a mental health professional finds it necessary.

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July 14, 2025

Mental Health Presumptions

Maine Indefinitely Extends PTSD Presumption for First Responders

Set to expire on October 30th, the state’s PTSD presumption no longer faces an expiration date.

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July 14, 2025

Presumptions

California Proposes Multiple New Presumptions for Hospital Workers

Senate Bill 632 would grant these workers presumptions for musculoskeletal injuries, COVID-19, respiratory disease, cancer, and PTSD.

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July 14, 2025

Industry Data

California Reports on Independent Medical Reviews (IMRs)

The report reviews 1.57 million IMR decision letters from 2015 through March 2025.

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July 14, 2025

Advocacy Opportunity Treatment Guidelines

California P&T Committee Reviews Drug List Changes

The July 16th meeting will review upcoming MTUS changes, which go into effect August 6th.

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July 14, 2025

Billing & Payments Cost Containment

Wisconsin WCAC Meeting Shares Key Regulatory Updates

Among other updates, Wisconsin will implement a hospital fee schedule by July 1, 2027.

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July 14, 2025

Ancillary Services Cost Containment

Alaska Considers Reimbursement Changes for Home Health, DME, And Ambulance Services

The proposed changes will be discussed further in the next meeting on July 18th.

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July 14, 2025

Technology

WCRI Publishes Overview of AI Promises and Challenges

The study is based on an exploration of literature and interviews with 34 leaders across workers’ comp.

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June 30, 2025

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Further resources you may be interested in

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

Maryland and Arizona Enact New Psychedelic Laws

A Maryland taskforce will plan regulation, while Arizona will tentatively cover MDMA treatment for first responders with PTSD.

Positive Marijuana Screenings Increase – What More to Expect with Rescheduling?

New data from Quest Diagnostics 2024 Drug Testing Index, and industry leaders discuss how rescheduling will impact workers’ comp.

Physician Dispensing Concerns in Workers’ Compensation

Physician dispensing represents an ongoing challenge for today’s workers’ comp payers – not only from a cost perspective, but from clinical and safety perspectives.