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

Pennsylvania Supreme Court Reviews Drug Pricing Case

The case will examine the Bureau of Workers’ Compensation’s use of RED BOOK for calculating AWP.

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December 8, 2025

Cost Containment

CMS Publishes 2026 Q1 NCCI Edits

Changes will impact DME supplier services, facility outpatient hospital services, and practitioner services.

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December 8, 2025

Claim Data

Delaware and Pennsylvania Expand Medical Data Call Reporting

Insurers with 0.25% of market share must begin sharing data by July 1, 2026, while those with lower market share must begin by January 1, 2027.

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December 8, 2025

Advocacy Opportunity Ancillary Services Claims Procedures

Nevada Schedules Workshop to Review Reform Rule Changes

This workshop will cover rules around panel provider lists, delegating follow-up care to physician assistants, and other clerical matters.

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December 8, 2025

Industry Data

Texas Finalizes Designated Doctor Plan-Based Audit

The audit will evaluate the medical necessity and reasonableness of referrals and diagnostic testing ordered by designated doctors.

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November 24, 2025

Claims Procedures Presumptions

Florida May Permit Older Physical to Help Establish First Responder Presumptions

Exams from previous employers could be used to demonstrate that workers had no signs of occupational illnesses prior to employment.

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November 24, 2025

Claim Data Industry Data

California Publishes 2025 Geo Study

The study explores regional differences in claims patterns and cost drivers across the state.

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November 24, 2025

Worker Safety

Congressional Bill Proposes Safety Standards for Wildland Firefighters

The bill would require federal agencies to determine appropriate protective equipment and under what conditions such equipment would be required.

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November 24, 2025

Advocacy Opportunity Mental Health Treatment Guidelines

California Proposes Updates to Mental Health Treatment Guidelines

Public comments will be accepted on proposed guideline updates until December 19, 2025.

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November 24, 2025

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Further resources you may be interested in

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

The Cannabis Question: Marijuana and Workplace Safety?

With greater legalization and public approval, the question of safety grows more important.

Rhode Island Legalizes Recreational Marijuana

A total of 19 states now allow for recreational marijuana in adults aged 21 and older.

The Cannabis Question: Marijuana and Workplace Safety?

With greater legalization and public approval, the question of safety grows more important.

Changing Workforce, Claims Automation and Tech Connectivity Among Top Priorities in 2022 Industry Survey

The priorities and challenges revealed in our 2022 Workers’ Compensation Industry Insights Survey Report reflect an industry focused on moving forward.