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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Claims Procedures

Indiana Limits IME Record Submission

When submitting records for IMEs, parties must limit documentation to 500 pages.

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July 13, 2026

Florida Sets Hearing for Physician Dispensing Rules

The hearing will take place on July 15th, allowing interested stakeholders to attend virtually.

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June 29, 2026

Presumptions

Arizona Expands First Responder Protections

One bill expanded the existing cancer presumption, while another established wage-based survivor benefits.

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June 29, 2026

Access to Care Claim Data

Texas Publishes Designated Doctor Report

Designated doctors are selected to evaluate medical issues in claims, such as MMI, impairment ratings, disability, and more.

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June 29, 2026

Billing & Payments Cost Containment

Pennsylvania Supreme Court Rules in Favor of Physician-Owned Pharmacies

Anti-referral provisions do not prohibit physicians from referring injured workers to pharmacies in which they have a financial interest.

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June 22, 2026

Advocacy Opportunity Cost Containment Treatment Guidelines

Michigan Proposes Limiting Physician Dispensing to First 42 Days of Care

As part of proposed updates to the Healthcare Service rules and the state fee schedule, additional changes are up for debate.

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June 22, 2026

Access to Care

New York Expands Provider Access and Raises Authorization Threshold

Any licensed healthcare provider in good standing may treat injured workers, and prior auth thresholds increase from $1,000 to $1,500.

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June 22, 2026

Ancillary Services Claim Costs Cost Containment

CWCI Report: Increased Use of Unlisted Billing Codes Driving Medical Inflation

Payments for unlisted professional service more than doubled from 2017-2024.

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June 22, 2026

Advocacy Opportunity Cost Containment

Florida Amends Billing Rules After Physician Dispensing Ruling

The proposed rules would align with the February 2026 ruling on physician dispensing in Publix Super Markets, Inc. v. Department of Financial Services.

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June 15, 2026

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Further resources you may be interested in

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

Cannabis Drug Beats Opioids in Phase 3 Low Back Pain Trial

VER-01, a cannabis extract, outperformed both placebo and opioids in two late-stage clinical trials.

NCCI Publishes 2025 Regulatory and Legislative Trends Report

NCCI tracked 950 bills impacting workers’ comp, highlighting key trends across the country, such as PTSD and cancer presumptions, worker classification, and psychedelics.