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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Access to Care Ancillary Services

Delaware Approves 125% Medicare Reimbursement Rate for E&M Procedures

The adjustment aims to address longstanding underpayment for E&M services, as low reimbursement has contributed to provider shortages.

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September 15, 2025

Industry Data

Study Finds Long COVID Linked to Productivity Loss

Participants who reported ongoing long COVID symptoms were more than three times more likely to report work productivity loss than those without persistent symptoms.

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September 8, 2025

Cost Containment

CMS Publishes 2025 Q4 NCCI Edit Updates

The changes are effective October 1, replacing the 2025 Q3 versions.

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September 8, 2025

Advocacy Opportunity Billing & Payments

Ohio BWC to Refile Outpatient Medication Rules

The BWC withdrew its proposed outpatient medication reimbursement rules for self-insured employer claims due to a technical error.

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September 8, 2025

Cost Containment

NCCI Publishes New Research Brief on Medical Fee Schedules

The report reviews how changes to CMS reimbursement rules may impact medical costs in workers’ comp.

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September 1, 2025

Worker Safety

CPWR Publishes Report on Heat Injuries and Illness Among Construction Workers

While construction workers make up only 7% of the workforce, they account for more than one-third of occupational heat-related deaths in the U.S.

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September 1, 2025

Mental Health Presumptions

New Jersey Now Requires Counseling for First Responders After Traumatic Incidents

Effective immediately, workers’ comp programs are required to pay for up to 12 hours of counseling following critical incidents.

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September 1, 2025

Advocacy Opportunity Treatment Guidelines

California Proposes Updates to Medical Treatment Utilization Schedule

Public comments can be made on the proposed changes until September 26th, at which point a hearing will be held.

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September 1, 2025

Advocacy Opportunity Cost Containment

Tennessee Medical Payments Committee Meeting Highlights

Discussions centered around the proposed medical fee schedule, particularly the Medicare negotiated pricing for pharmaceuticals.

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September 1, 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.