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 Claim Data

Texas Publishes Designated Doctor Report

Designated doctors are selected to evaluate medical issues in claims, such as MMI, impairment ratings, disability, and more.

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June 29, 2026

Billing & Payments Cost Containment

Pennsylvania Supreme Court Rules in Favor of Physician-Owned Pharmacies

Anti-referral provisions do not prohibit physicians from referring injured workers to pharmacies in which they have a financial interest.

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June 22, 2026

Advocacy Opportunity Cost Containment Treatment Guidelines

Michigan Proposes Limiting Physician Dispensing to First 42 Days of Care

As part of proposed updates to the Healthcare Service rules and the state fee schedule, additional changes are up for debate.

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June 22, 2026

Access to Care

New York Expands Provider Access and Raises Authorization Threshold

Any licensed healthcare provider in good standing may treat injured workers, and prior auth thresholds increase from $1,000 to $1,500.

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June 22, 2026

Ancillary Services Claim Costs Cost Containment

CWCI Report: Increased Use of Unlisted Billing Codes Driving Medical Inflation

Payments for unlisted professional service more than doubled from 2017-2024.

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June 22, 2026

Advocacy Opportunity Cost Containment

Florida Amends Billing Rules After Physician Dispensing Ruling

The proposed rules would align with the February 2026 ruling on physician dispensing in Publix Super Markets, Inc. v. Department of Financial Services.

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June 15, 2026

Marijuana

New Proposal Would Ban Cannabis Coverage in Federal Workers’ Comp Claims

If enacted, the ban would remain in effect regardless of rescheduling.

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June 15, 2026

Claims Procedures Cost Containment

California Proposes Contract-Based Medical Bill Reduction

If enacted, payers must identify a contact person for whom providers could reach for contract-based medical bill information.

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June 15, 2026

Claim Data

California Sees Increase in Cumulative Trauma Claims

Since 2020, total costs for CT claims have more than doubled, with CT claims more likely to involve medical-legal and interpreter services early on.

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June 15, 2026

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Further resources you may be interested in

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

Rescheduling Questions: How the Marijuana Landscape Could Soon Change

The rescheduling of marijuana may introduced significant implications for clinical research, drug development, and downstream utilization.

State of the Nation: Summer 2026

Healthesystems’ Sandy Shtab examines key workers’ comp policy trends, from PBM regulation and AI oversight to marijuana rescheduling and injured worker engagement.

Pennsylvania Proposes Reimbursement Caps for Compounds and Topicals

The bill would create a $400, 30-day supply cap for compound drugs.

New Jersey Proposes Marijuana Reimbursement in Workers’ Comp and Group Health

Companion bills S3984 and A1023 would require health insurance coverage for the medical use of cannabis under certain circumstances.

Florida Appeals Court Rules in Favor of Carriers and Employers on Physician-Dispensed Drugs

While injured workers have an absolute choice over their pharmacist, physicians are not considered pharmacists and therefore not entitled to reimbursement.