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A significant part of the Healthesystems vision is to create a more integrated experience for our customers

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.

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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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

Nevada Enacts Formulary and Changes for Provider Panels

The DIR must adopt the ODG formulary by July 1, 2027.
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June 16, 2025

New York Clarifies When Injured Workers Can Use Out of Network Pharmacies

Effective July 11th, the updated rules apply to controverted claims and other dispute conditions.
Read More →
June 16, 2025

Texas Publishes 2024 Health Care Cost and Utilization Report

Pharmacy service costs fell 40% - or $28 million dollars – from 2018 through 2023.
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June 9, 2025

Connecticut, Nebraska, Nevada, and Texas Introduce AI Regulation Bills

These different bills would prevent AI from denying, delaying, modifying, or making clinical decisions in healthcare.
Read More →
June 9, 2025

Colorado Injured Workers Can Now Choose Any Treating Provider

Injured workers may now choose any Level I or II accredited physician licensed under the Colorado Medical Practice Act.
Read More →
June 9, 2025

CWCI Publishes Report on Long-COVID

Long COVID cases made up 4.7% of COVID claims, totaling 6,000 claims, yet medical payments for long COVID claims was $105 million.
Read More →
June 9, 2025

Arizona Seeks Stakeholder Input on Prescription Topicals

The meeting will take place on June 12th, aiming to explore current trends, challenges, and proposed solutions related to these drugs.
Read More →
June 9, 2025

CMS Publishes 2025 Q3 Updates to NCCI Edits

Medically unlikely edits were updated across DME, outpatient hospital services, and more.
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June 9, 2025
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 Further resources you may be interested in

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

Wacky Weather: How Climate Change Is Impacting Workers’ Comp

Weather-related disasters are on the rise. How do weather and climate change affect workers and workers’ comp?
Read More

Missouri Enacts PTSD Presumption for First Responders

The national trend continues, in this case with qualifying events and the inclusion of 911 dispatchers.
Read More

FDA Publishes Guidance on Clinical Trials for Psychedelic Drugs

These guidelines advise researchers on study design and other considerations as they develop medications that contain psychedelics.
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Connecticut Passes PTSD Presumption for All Employees

Employees who experience a qualifying traumatic event on the job can receive PTSD coverage via workers’ comp.
Read More

Washington State Bans Pre-Employment Cannabis Screening

As other states come closer to recreational legalization, Washington State pushes the needle further.
Read More

Marijuana Reimbursement Initiatives See Signs of Life

Three states have introduced bills or seen court cases overturned in relation to this policy.
Read More
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