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A significant part of the Healthesystems vision is to create a more integrated experience for our customers

Regulatory Tag: Cost Containment

October 6, 2025
Arizona Study Prompts Stakeholder Feedback for High-Cost Prescription Topicals

A small group of prescribers and out-of-network pharmacies are driving utilization of costly drugs with affordable alternatives.

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September 29, 2025
Tennessee: Formulary and UR Updates from the Medical Advisory Committee Meeting

Advocacy efforts by Healthesystems helped create a prior authorization for 300mg ibuprofen, as other cost-effective doses are readily available.

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September 22, 2025
Massachusetts Seeks Stakeholder Input on Medical Payment Rates

The EOHHS hopes to understand how current rates affect workers’ comp coverage, access to care, quality of care, and injured worker experience.

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September 22, 2025
Oregon Seeks Stakeholder Recommendations for Medical Fee Schedule Rates

Public comments regarding fee and payment rules, medical services, and managed care organizations must be submitted by September 30th.

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September 22, 2025
Arizona to Hold Public Stakeholder Meeting on Topical Medications Regulation

The meeting will take place October 2nd and presents an opportunity to influence how topicals are regulated in the state workers’ comp system.

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September 11, 2025
California Bill Would Require EORs to Include Contract Information

Provider EORs would require contract-specific info. Not providing a requested contract in 30 days allows bills to be reprocessed at full fee schedule rates.

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September 5, 2025
CMS Publishes 2025 Q4 NCCI Edit Updates

The changes are effective October 1, replacing the 2025 Q3 versions.

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August 28, 2025
NCCI Publishes New Research Brief on Medical Fee Schedules

The report reviews how changes to CMS reimbursement rules may impact medical costs in workers’ comp.

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August 28, 2025
Tennessee Medical Payments Committee Meeting Highlights

Discussions centered around the proposed medical fee schedule, particularly the Medicare negotiated pricing for pharmaceuticals.

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August 18, 2025
California Shares Key Updates at CHWSC Meeting

Topics covered included recent MTUS updates, the pharmacy fee schedule update, UR and IMR updates, and more.

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August 15, 2025
Oklahoma Solicits Public Feedback on Medical Fee Schedule

Public comments will be accepted on the current fee schedule until September 7th.

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August 15, 2025
Alaska Finalizes 2026 Fee Schedule Recommendations

Recommended changes will be reviewed by the WCB and MSRC on August 22nd, with final adoption expected in October, and taking effect in 2026.

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August 11, 2025
South Dakota Approves Rulemaking for Physician Fee Schedule

The 2025 Optum RVPs for medical services and treatments will be adopted, but with current conversion factors.

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August 1, 2025
California Publishes 2025 State of the System Report

Medical costs went up 8% in 2024, driven by increased utilization, fee schedule inflation, and growth in medical-legal services.

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August 1, 2025
California Sees Delay to Utilization Review Regulations

The Office of Administrative Law informed the DWC that seven areas of the proposed update required additional clarification or public notice.

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