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Exploring health policy: Federal Register rules, regulations, and notices



Government health policy has an impact on nearly every aspect of healthcare delivery. It drives payment methodology, influences the quality of the care that is delivered, and affects the day-to-day operations of healthcare systems. In short, it creates the environment in which nurses and other providers deliver health care to patients and populations. As the largest single group of healthcare providers (3.4 million), it is essential that registered nurses (RNs) engage in the formulation and development of health policy, particularly since physicians and other providers, as well as healthcare entities (such as insurance companies and hospitals), have a strong voice in healthcare matters.

What is health policy?

Policies are “authoritative decisions made within government,” and public-sector health policy includes “authoritative decisions regarding health or the pursuit of health made in the legislative, executive, or judicial branches of government that are intended to direct or influence the actions, behaviors, or decisions of others.” All levels of government (federal, state, and local) establish health policies.

One aspect of the American Nurses Association’s (ANA) health policy work at the federal level involves monitoring the actions of agencies. This is accomplished, in part, by reviewing and analyzing proposed rules, final rules and regulations, notices, and Presidential documents (such as executive orders) published in the Federal Register. Through review and analysis, we not only become aware of the planned activities of executive agencies, but also can help shape those activities by providing comments on how the policies will affect nurses, patients, and the broader healthcare system.

Understanding the Federal Register

The Federal Register was created by the Federal Register Act (FRA) in 1935. It is a repository of documents for public inspection. The Federal Register includes final rules and regulations published by executive agencies; proposed rules (called notices of proposed rulemaking), requests for information, and other documents seeking public comment; presidential documents (including presidential proclamations and executive orders); and agency notices that provide information to the public.

The framework initially established by the FRA was further refined by the Administrative Procedures Act in 1946, which standardized the rulemaking process and established a mechanism for the public to comment on pending regulations. The advent of the digital age has made it easier than ever to follow the proposals of federal agencies and administrations. The Federal Register is available electronically for review at, while documents scheduled for future publication in the Federal Register are available for advance review by the public at

Writing regulatory comments

ANA staff review and analyze federal agency decisions, regulations, and rules affecting registered nurses, our profession, our patients, and the public health, and develop feedback to federal policymakers through written comments. ANA’s interdepartmental regulatory team comments on a wide range of regulatory issues and topics, including payment methodologies, care coordination, interoperability of healthcare records, discharge planning, and many other topics. Once ANA comment letters are submitted to the agency (generally through, they are posted on at ANA Advises Federal Agencies.

A significant rule was recently proposed by the Department of Veterans Affairs (VA). The proposed rule would standardize the practice of advanced practice registered nurses in the VA system to allow practice to the full extent of education, training, and certification without regard to individual state practice regulations concerning requirements such as clinical supervision or mandatory collaboration with physicians. The rule has important implications for the nursing profession and also would affect critical issues concerning the access of our nation’s veterans to timely, high-quality health care. You can learn more about this regulation and how to submit comments on the proposed rule (due July 25) by visiting It’s essential that nurses have a voice in crafting this type of policy.

The regulatory team works collaboratively within ANA and also welcomes the opportunity to work with our constituent/state nursing associations, organizational affiliates, and other nursing and healthcare organizations to develop comments on issues of mutual interest and concern. Please contact ANA’s regulatory team with any questions concerning advocacy and federal regulatory policy at

Selected references

American Nurses Association. ANA Advises Federal Agencies. 2016.

Bunk A. Federal Register 101. The Coast Guard Proceedings of the Marine Safety and Security Council. 2010.

Federal Register. Department of Veterans Affairs. Advanced Practice Registered Nurses; Proposed Rules. May 25, 2016;81(101).

Longest B. Health Policymaking in the United States. 6th ed. Chicago, IL: Health Administration Press; 2016.


Jane Clare (JC) Joyner is the senior policy advisor, health systems and regulatory policy in the Department of Health Policy at the American Nurses Association.


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