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

Hawaii Could Expand Firefighter Cancer Presumption

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

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February 9, 2026

California Publishes Independent Billing Review Report

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

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February 9, 2026

Claim Data

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.

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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.

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February 9, 2026

Cost Containment Treatment Guidelines

Hawaii Bills Target Pharmacy Management Rules

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

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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.

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February 2, 2026

Technology

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.

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February 2, 2026

Presumptions

Arizona Could Cover Travel Injuries for Firefighters

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

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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.

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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.

Expert Q&A: Cybersecurity Tactics in Workers’ Compensation

RxInformer editors sat down with Healthesystems’ AVP of Information Security and resident cybersecurity expert, Tony Brown, to discuss how cyber threats affect workers’ comp organizations.

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.