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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Cost Containment

CMS Finalizes 2026 Medicare Physician Fee Schedule

States that base their workers’ comp fee schedules on the CMS Fee Schedule may adopt these adjustments, which go into effect January 1st.

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November 17, 2025

Massachusetts Advisory Council Discusses Medical Fee Schedule

The fee schedule has not been updated since 2009, resulting in low reimbursement rates, which has impacted access to care.

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November 17, 2025

Billing & Payments Claims Procedures Cost Containment

New Mexico Revises Rules for Fee Schedule Changes

Effective January 1st, CARC and RARC codes will be permitted for use in EOBs, leveraging nationally recognized standards.

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November 17, 2025

Claims Procedures Presumptions

Wisconsin Introduces Significant Reform Bill

Assembly Bill 651 could impact benefits levels, PTSD presumptions, penalties, and more

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November 17, 2025

Industry Data

Texas Issues Data Call

The call focuses on annual experience and workers’ comp deductible plans for the period of January 1, 2025, through December 31, 2025.

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November 17, 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

Access to Care Billing & Payments Claims Procedures

Michigan Introduces Bill to Strengthen Injured Worker Protections

The bill impacts required medical services, provider choice, preauthorization requests, and more.

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November 10, 2025

Presumptions

Michigan Considers Infectious Disease Presumption for Essential Workers

The bill would apply to those required to work during a state of emergency to protect life or maintain critical operations.

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November 10, 2025

Advocacy Opportunity Claims Procedures

California Considers Rule Change for Greater E-Filing in Workers’ Comp

Proposed updates also allow for electronic filing and service of all WCAB case related documents in EAMS rather than requiring service by mail.

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November 10, 2025

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Further resources you may be interested in

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

Common Exceptions: The Rising Incidence of Complex Claims in Workers’ Compensation

Understanding the factors that drive longer claim duration and higher costs.

California to Expedite Research Around Schedule I & II Drugs

Assembly Bill 1103 was enacted, allowing for the Research Advisory Panel to expedite the review and approval of research applications.

Healthe Leaders Share Insights

CEO Daryl Corr and SVP Todd Piscoitti were featured in WorkCompWire’s Leaders Speak series, while VP of Clinical Services, Silvia Sacalis’ recaps her National Comp presentation.