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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Cost Containment Treatment Guidelines

Arizona Proposes $300 Topical Prescription Cap

The cap is for a 30-day supply. If actual acquisition cost exceeds $300, reimbursement would be limited to 120% of documented AAC.

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August 10, 2026

Claim Data

California Publishes Study on Cumulative Trauma Claims

CT claims nearly doubled from 9.1% of claims to 16.5% from 2018-2025, with these claims increasing across all regions, demographics, and tenures.

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August 10, 2026

Advocacy Opportunity Cost Containment Treatment Guidelines

Colorado Gathers Stakeholder Feedback for Rulemaking Updates

Impacted items would include pharmacy and topical reimbursement, home health, prior authorization, and more.

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August 10, 2026

Access to Care Claims Procedures

New York Broadens Pay Without Prejudice Rules

Effective January 1, 2027, payers may voluntarily cover medical treatment for up to one year while compensability determination is under review.

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August 3, 2026

Advocacy Opportunity Cost Containment Treatment Guidelines

Texas Seeks Input on Draft for Topical Analgesic Audit

Stakeholder feedback for the audit plan will be accepted until 5:00 PM CST on August 6th.

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August 3, 2026

Access to Care Treatment Guidelines

CHSWC Releases 2025 Annual Report

Recommendations from the California report touched on pharmacy topics and access to care.

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August 3, 2026

Worker Safety

Congressional Bill to Remove Federal Heat Standards Advances

If enacted, OSHA would be prevented from adopting heat protection standards proposed in 2024, or any substantially similar rule.

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August 3, 2026

Ancillary Services Claim Data

WCRI Reports on Trends in Non-Price-Controlled Medical Services

The study focused on DME and professional services billed by nonhospital providers from January 1, 2010 through June 30, 2025.

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August 3, 2026

Advocacy Opportunity Treatment Guidelines

Pennsylvania Advisory Council Provides Pharmacy and Study Updates

The meeting discussed issues that could affect pharmacy reimbursement, statutory provider definitions, and medical accessibility reporting.

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July 27, 2026

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Further resources you may be interested in

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

Eighth Annual Industry Insights Survey Reveals Focus on Injured Worker Engagement

Explore the top five major findings from this year’s Workers’ Comp Industry Insights Survey.

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?

The Cost of Exposure: How Occupational Cancer Impacts Workers’ Compensation

The risk and impact of occupational cancers vary significantly depending on the nature of the exposure and the affected workforce.

Utah Launches AI Prescription Renewal Pilot Program for Chronic Conditions

The pilot can approve a limited set of 192 medications and will be broken into three stages, each with different levels of review.

States Seek to Limit AI-Generated Care Decisions, Despite White House Order

Legislators continue to introduce bills to limit AI-generated healthcare decisions, even as the U.S. Attorney General has been instructed to oppose them.