Regulatory Advocacy

The Society of Hospital Medicine (SHM) works closely with the Centers for Medicare and Medicaid Services (CMS) and other federal agencies as they implement programs and initiatives authorized by law. SHM provides comments on proposed regulations, requests for information and other agency activities to ensure the voices of hospitalists and their patients are considered throughout the process.

Overview of the Regulatory Process

The Federal Rulemaking Process

The proposed rule, or Notice of Proposed Rulemaking (NPRM), is the official document that announces and explains the agency’s plan to address a problem or accomplish a goal. All proposed rules must be published in the Federal Register to notify the public and to give them an opportunity to submit comments. The proposed rule and the public comments received on it form the basis of the final rule. In general, agencies will specify a comment period ranging from 30 to 60 days in the “Dates” section of the Federal Register document, although this time period can vary.

What is the Purpose of a Proposed Rule?

Congress may pass a law that directs an agency to take action on a certain subject and set a schedule for the agency to follow in issuing rules. An agency may also survey its area of legal responsibility, and decides which issues or goals have the need for rulemaking.

Some factors that an agency may consider when making or amending rules include:

  • New technologies or new data on existing issues;
  • Concerns arising from accidents or various problems affecting society;
  • Recommendations from congressional committees or federal advisory committees;
  • Petitions from interest groups, corporations, and members of the public;
  • Lawsuits filed by interest groups, corporations, states, and members of the public;
  • Presidential directives;
  • “Prompt letters” from the Office of Management and Budget (OMB);
  • Requests from other agencies; and
  • Studies and recommendations of agency staff.

How Do Public Comments Affect a Final Rule?

The notice‐and‐comment process enables anyone to submit a comment on any part of the proposed rule. This process is not like a ballot initiative or an up‐or‐down vote in a legislature. An agency is not permitted to base its final rule on the number of comments in support of the rule over those in opposition to it. At the end of the process, the agency must base its reasoning and conclusions on the rulemaking record, consisting of the comments, scientific data, expert opinions, and facts accumulated during the pre‐rule and proposed rule stages. SHM often submits public comments and tracks the impact of its comments on final rule determinations.

Recent Letters to Regulatory Agencies

Medicare Appeals - Feb 12  
SHM Joins the AMA and Other Organizations in a Letter of Concern about the Backlog of Medicare Appeals
Read the February 12 letter here.

Measures Under Consideration - Jan 31  
SHM Provides Feedback to CMS about Performance Measures included in the List of Measures Under Consideration December 2013
Read the January 31 letter here.

Implementing Two-Midnight Rule - Jan 30  
SHM Public Policy Committee Provides Suggestions to CMS on Implementing the Two-Midnight Rule
Read the January 30 letter here.