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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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

Industry Data

Oregon Publishes Biennial Premium Rate Comparison Study

The study focuses on Oregon’s 50 largest industry classes, comparing data to every other state in the country.

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June 30, 2025

Access to Care Ancillary Services

Oregon Expands Waiver Enforcement for Sign Language Interpreters

The extension will allow sign language interpreters with temporary licenses to continue providing services through June 30, 2026.

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June 30, 2025

Access to Care Cost Containment

Connecticut Adjusts Process to Update Fee Schedules

Effective July 1st, fee schedule adjustments can be made by the Workers’ Compensation Commission without revenue neutrality.

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June 30, 2025

Cost Containment

WCRI Publishes New Report on Medical Fee Schedule Design

The study compares workers’ comp fee schedules for professional services to Medicare rates within 44 states, accounting for 41% of medical costs.

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June 30, 2025

Advocacy Opportunity Industry Data

Washington Advisory Committee Meeting Highlights

The meeting focused on long-term disability claims, going into IMEs and PTSD claims.

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June 30, 2025

Advocacy Opportunity Cost Containment Treatment Guidelines

Arizona Commission Discusses Trends and Solutions for Topical Prescriptions

Fee schedule clarity and defined reimbursement caps were discussed as ways to reduce ambiguity and prevent payment disputes.

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June 16, 2025

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Further resources you may be interested in

Additional articles and updates from Healthesystems related to policy shaping 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.

Triple Threat: Healthcare Fraud, Waste and Abuse in Workers’ Comp

Identifying and combating a multifaceted problem, including proven and developing strategies.

WCRI Publishes 24th Edition of CompScope Benchmarks

A total of 14 different reports examine workers’ comp system performance across 17 states from 2017-2022.

DEA to Reschedule Marijuana

While bureaucratic wheels may take time, marijuana will become a Schedule III drug soon.

Triple Threat: Healthcare Fraud, Waste and Abuse in Workers' Comp

A current look at fraud, waste and abuse in workers’ comp pharmacy and medical services with strategies for management, including next-generation strategies involving AI.