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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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

Ancillary Services Claim Costs Cost Containment

NCCI Reports on Trends in Home Health and Skilled Nursing Facilities

Claims exceeding $1 million in costs saw a projected home health share of medical costs reach 20.1%.

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November 24, 2025

Cost Containment Pharmacy Data

Minnesota Reports on Prescription Drug Price Transparency

Drug classes with the most new, high-priced drugs were anti-cancer drugs, ADHD/anti-obesity drugs, and anti-inflammatory pain medications.

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November 24, 2025

Treatment Guidelines

New York Bill Could Remove References to CDC Guidelines

Existing laws and guidelines that refer to CDC guidelines would shift to “nationally recognized clinical practice guidelines.”

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November 17, 2025

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Further resources you may be interested in

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

Congressional Budget Bill Could Place 10-Year Ban on State AI Regulations

If passed, the bill would prevent the enforcement of laws on AI models and automated decision systems.

Then and Now: 8 Reflections from 15 Years of RxInformer

In celebration of the 15 year anniversary of RxInformer, the editorial staff looked back at past issues to understand what has changed – and what hasn’t.

WCRI Reports on the Impact of Marijuana Laws on Workers’ Comp Benefits

While recreational marijuana laws may be tied to increases in claim frequency, medical payments and prescriptions decreased, including those for opioids.