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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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Oklahoma Bills Would Create Conflicts for Workers’ Compensation Pharmacy

Two Oklahoma bills heading for House consideration would establish a NADAC based reimbursement floor, minimum dispensing fees, and a shortened 30 day payment timeframe.
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March 30, 2026

DME Vendors Are Not “Providers” Under Pennsylvania Workers’ Comp Law

A Pennsylvania appellate court ruled that a distributor of Durable Medical Equipment (DME) does not qualify as a “healthcare provider” under the Workers’ Compensation Act and therefore cannot use the state’s medical fee review process to dispute reimbursement.
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March 30, 2026

New York Proposes Regulations Expanding Pay Without Prejudice Rules for Medical Payments

The New York Workers’ Compensation Board has proposed rules allowing carriers to temporarily pay for medical treatment while compensability is under review, without admitting liability.
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March 30, 2026

Colorado Will Host Fee Schedule Listening Session

The Colorado Division of Workers’ Compensation (DOWC) will host a listening session on April 9, 2026 at 4:00 p.m. MT to gather feedback from employers, insurers, providers, and other workers’ compensation stakeholders on Rule 18 (Medical Fee Schedule).
Read More →
March 30, 2026

Arizona Publishes 2026 Medical Fee Schedule

The updated schedule increases the maximum reimbursement for topical compounds and urges pharmacies to select the lowest-AWP medication when available, among other changes.
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March 30, 2026

Idaho Bill Would Expand the Definition of “First Responder” for PTSD Coverage

The new bill would add coroners, “medicolegal” death investigators, and qualifying coroner employees to the list of first responders eligible for workers’ compensation benefits for post-traumatic stress injuries.
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March 30, 2026

Pennsylvania Proposes Price Caps on Compound and Topical Drugs

Senate Bill 1215 proposes a $400, 30-day supply cap for compound drugs and a $240, 30-day supply cap for non-compound topicals.
Read More →
March 23, 2026

Florida Appeals Court Rules in Favor of Carriers and Employers on Physician-Dispensed Drugs

While injured workers have an absolute choice over their pharmacist, physicians are not considered pharmacists and therefore not entitled to reimbursement.
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March 2, 2026

Hawaii May Require Compounds to Be Created by Licensed, In-State Pharmacists

The state’s definition of “compounded prescription drug” would be updated to fall in line with federal standards.
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March 23, 2026
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 Further resources you may be interested in

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

WCRI Publishes New Report on Medical Fee Schedule Design

The study compares workers’ comp fee schedules for professional services to Medicare rates within 44 states, accounting for 41% of medical costs.
Read More

Healthesystems at WCI 2025

Visit Healthe at Booth #921 to learn about our solutions and how we reduce burdens for claims professionals.
Read More

Expert Q&A with Sandy Shtab: The Emerging Role of AI in Workers’ Comp Healthcare – and the Regulations Surrounding It

AI is increasingly being used in healthcare delivery. What are its applications in workers’ comp? What are the benefits and risks?
Read More

WCRI Publishes Medical Price Index

The study compares prices for medical services across 36 states from 2008 to 2024, representing 88% of workers’ comp benefits in the U.S.
Read More

Highlights from the NCCI Annual Insights Symposium 2025

In-depth reports cover topics ranging from an overview of the workers’ comp system to opioids, industry-specific trends, and more.
Read More

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.
Read More
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