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

South Carolina to Cover Stroke for Firefighters

The bill also expands presumption eligibility to cover conditions that arise during training, rescue activity, or within 24 hours of strenuous duty.

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June 8, 2026

Cost Containment Treatment Guidelines

Wisconsin Shares Updates on Medical Treatment Guidelines and Hospital Fee Schedule

While progress continues, the guideline updates are delayed due to quorum issues, and the hospital fee schedule is still in early planning stages.

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June 1, 2026

Claim Costs Claim Data Industry Data

WCRI Publishes 2026 Medical Price Index

The report compares prices paid for medical services across 36 states from 2008 to 2025.

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June 1, 2026

Claim Data Pharmacy Data

California Publishes Independent Medical Review Report

Pharmaceutical requests represented 30.6% of all treatment requests submitted for IMR, a modest decline from 32.7% in 2024.

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May 25, 2026

Mental Health Psychedelics

Georgia Enacts Regulations for Psychedelic Clinics

The Georgia Composite Medical Board will issue rules and regulations for clinics administering psychedelic-assisted therapies by December 31, 2026.

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May 25, 2026

Presumptions

Colorado Could Expand Cancer Coverage for Firefighters

Senate Bill 184 passed both chambers and now sits with Governor Polis.

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May 25, 2026

Claim Costs Pharmacy Data

WCRI Publishes Interstate Variation and Trends Report on Drug Payments

Dermatological agents remained a significant cost driver, in part due to physician dispensing and delivery pharmacies, which accounted for a significant number of high-cost transactions.

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May 25, 2026

Advocacy Opportunity Ancillary Services Treatment Guidelines

Montana Proposes Updates to Formulary and Fee Schedule, Requesting Stakeholder Feedback

A remote hearing will be held on May 28th, with comments accepted through June 5th. If enacted, changes will take effect July 1st.

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May 18, 2026

Psychedelics

Oklahoma Enacts Law for Ibogaine Clinical Trials

Effective November 1st, the Department of Health can enter into contracts with drug developers to conduct ibogaine clinical trials.

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May 18, 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: What Utah’s AI Prescription Renewal Pilot Signals About the Evolving Role of AI in Treatment Decisions

Utah’s prescription renewal pilot is a groundbreaking use case for AI in healthcare. What are the potential benefits and pitfalls?

Inside Medical Experience: Signals, Trends, and System Impact

Healthe’s VP of Industry and State Affairs, Sandy Shtab, joins a panel presentation at the Pennsylvania/Delawaare 2026 Workers’ Compensation Symposium.