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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Worker Safety

Massachusetts Introduces Extreme Temperature Protection Bill

The bill contains measures for temperatures below 60 degrees Fahrenheit, and above 90 degrees Fahrenheit.

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August 17, 2026

Marijuana

Colorado Study Evaluates Cannabis Reimbursement in Workers’ Comp

Among many aspects, the program involved a specialized medical cannabis physician who managed dosing, titration, and cannabinoid ratios.

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August 10, 2026

Cost Containment

CMS Proposes 2027 Medicare Physician Fee Schedule Updates

Proposed changes would impact reimbursement for telehealth, evaluation and management, and more.

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August 10, 2026

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

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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.