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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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OSHA to Hold Public Hearing on Heat Injury and Illness Prevention

A June 16th virtual hearing will discuss proposed rules, and those interested in speaking must register by May 2nd.
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April 21, 2025

CMS Publishes Update to NCCI Medically Unlikely Edits

The update includes a revised MUE value for certain HCPCS codes, retroactive to October 1, 2024.
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April 21, 2025

New York Bill Would Ensure Coverage During Disputes

Employers or insurers would be required to provide immediate medical treatment. If a claim is not compensable, they could seek reimbursement.
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April 21, 2025

Montana to Allow Physician Assistants and Physical Therapists to Treat Injured Workers

Physician assistants will be able to conduct impairment ratings, while physical therapists are now included in the definition of treating providers.
Read More →
April 21, 2025

California P&T Committee Meeting Recap

Healthe attended the April 16th meeting, capturing key updates regarding the pharmacy fee schedule and drug formulary.
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April 21, 2025

Wisconsin May Expand PTSD Presumption to Emergency Medical Workers and Others

The existing presumption only applies to firefighters and law enforcement officers, while this new bill would apply to other first responders.
Read More →
April 14, 2025

Ohio Withdraws Outpatient Medication Reimbursement Rules

Filed in October 2024, the amendments aimed to adjust AWP discount rates and standardize dispensing fees.
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April 14, 2025

Nevada Now Considering Evidence-Based Formulary After Bill Hearing

Senate Bill 317 originally focused on provider panels, but a recent hearing amended the bill to include a workers’ comp formulary.
Read More →
April 14, 2025

Louisiana Proposes a Workers’ Comp Fee Schedule

The bill could require biennial updates, utilizing RVUs form the resource-based relative value scale (RBRVS).
Read More →
April 14, 2025
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 Further resources you may be interested in

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

Wisconsin Announces Plan to Lower Prescription Drug Costs

State-led efforts to combat the drug price issue continue to emerge across the nation.
Read More

COVID-19 Mutations Impact Testing

False negatives may be reported due to genetic variations of the virus.
Read More

Worker Classification Debate Continues Across the Country

The Department of Labor issued a new rule while special interest groups push for regulatory change.
Read More

The Department of Justice Sues Walmart Over Role in Opioid Crisis

Alleged violations of the Controlled Substances Act could result in billions of dollars in penalties.
Read More

Top 10 Disruptors of 2020 for the Workers’ Comp Industry

Initial insights from Healthesystems’ annual industry survey.
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FDA Authorizes Two COVID-19 Vaccines, At-Home Test, More Treatments

Vaccine candidates from Pfizer-BioNTech and Moderna received EUAs, as did the first at-home test that delivers results in 30 minutes, and two treatments for the virus.
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