How to comment on a proposed health rule

The short answer

• Anyone can comment, and you do not need a lawyer. When an agency publishes a proposed rule for comment, it must give the public a set period to send written comments, and it must consider them before deciding on the final version.
• Federal rules: open the proposal on FederalRegister.gov or Regulations.gov and use its comment button. Submit before the deadline printed in the notice. Many deadlines are set in Eastern Time, and some close at 5 p.m., not midnight. Save your tracking number.
• California rules: the agency's Notice of Proposed Action names where to send comments and the closing date. Agencies must allow at least 45 days. You can ask for a public hearing in writing at least 15 days before the comment period closes.
• Your comment will probably be public, with your name if you give one. Leave out diagnoses, record details, ID numbers and other people's information.
• It is not a vote. One specific comment with facts or an alternative may count for more than many copies of a form letter.

First, check that a comment is the right tool

A proposed rule (or proposed regulation) is a draft binding rule from a government agency, such as the Centers for Medicare & Medicaid Services (CMS) or the California Department of Public Health. The agency takes comments, then issues a final rule, changed or as proposed.

A comment shapes a rule that is still open. It will not fix your own claim, bill or complaint; use your health plan's appeal or grievance process or the agency that handles complaints. Bills are not rules; contact your elected representatives about those. Not sure whether a rule is still a proposal? See Proposed, final or in effect? For how statutes, regulations and guidance differ, see Statute vs. Regulation vs. Guidance.

Federal rules, step by step

1. Find the proposal and its docket

Federal agencies publish proposed rules in the Federal Register, the government's daily journal. Most also appear on Regulations.gov, where you can search by keyword, agency or docket number and filter for documents open for comment, or use the "Comments Due Soon" links on the home page.

A docket is an online folder holding the proposal, supporting documents and public comments. One rule carries several numbers. Match at least two before you submit: the agency's file code (for example, CMS-4214-P), the Federal Register document number (2026-21420), the Regulation Identifier Number or RIN (0938-AV88), and the Regulations.gov docket ID (CMS-2026-3533).

Some agencies do not use Regulations.gov. The ADDRESSES section of every notice says how to comment.

2. Read the parts that matter to you

You do not have to read everything; the example notice below runs to 82 pages. Start with:

• The plain-language summary. Since 2023, federal law has required a summary of 100 words or fewer for proposed rules, posted on Regulations.gov.
• SUMMARY, DATES, ADDRESSES and FOR FURTHER INFORMATION CONTACT at the top of the notice.
• The agency's own questions. Search for "seek comment", "seeks comments" or "solicit comment". Agencies ask where they want more information, and an answer from real experience helps.
• The section that affects you. Note its section number and page.

If something is unclear, ask the contact person named in the notice, but send the comment itself through the official channel.

3. Read the deadline carefully: a dated example

This proposal was open for comment when checked on October 21–22, 2026. It is shown only to illustrate how to read a notice, not as a view on it.

Three lessons:

1. Use the earliest time you see. Regulations.gov's general rule is that a due date runs to 11:59 p.m. Eastern, and its form for this rule was set to close then (8:59 p.m. Pacific). But CMS's notice says comments must be received by 5 p.m. Eastern "to be assured consideration." Plan around the earlier time.
2. "Received" means received. A comment mailed on time can still arrive late.
3. Check the docket number. The notice's ADDRESSES section printed docket CMS-2026-2533. When checked on October 22, 2026, Regulations.gov had no docket with that number; the Federal Register's "Submit a public comment" link went to CMS-2026-3533, which Regulations.gov titles differently. Match the file code and document number.

4. Submit and keep proof

• Use the comment button on the FederalRegister.gov page or the Regulations.gov document or docket page.
• Type your comment, attach files, or both. Regulations.gov takes up to 20 files of up to 10 MB each, including .docx, .pdf, .rtf and .txt. Name them "Attachment1_[title]", "Attachment2_[title]" and so on.
• Identify yourself as an individual (first and last name required, and they may be published), an organization, or anonymous.
• A comment tracking number appears when you submit. Anonymous commenters cannot get the email confirmation, so write the number down or take a screenshot.
• Keep your own copy in case the form fails.
• Submitted comments cannot be edited. To fix an error, submit a new comment that cites the first one's tracking number. To ask about withdrawal, contact the agency contact person.
• On busy rules, posting can take several weeks.

Writing a comment the agency can use

• Name the rule and the section at the top: file code or docket ID, section numbers, pages.
• Say who you are and why it affects you, in general terms: patient, caregiver, health worker, interpreter, small-business owner.
• Make one point per paragraph, and pick the issues you know.
• Back it up with facts, numbers, studies, concrete examples, or cost estimates that show how you reached them.
• Answer the agency's own questions where you can.
• If you disagree, offer an alternative and explain how it would meet the same goal. Address the trade-offs.
• Any length is fine. There is no minimum or maximum.
• Use your own words. Agencies decide on reasons and evidence, not vote counts. CMS discourages duplicate comments, though it posts identical ones from different people.
• Keep it civil. CMS says it will not post comments that threaten people or institutions.

Notice what the example leaves out: the father's name, diagnosis, member number and doctors' names.

Comments are public: protect your health privacy

Leave out:

• diagnoses, test results, medicines and treatment details that could identify you
• medical record numbers, Medicare or Medi-Cal numbers, insurance member IDs and Social Security numbers
• your date of birth, home address and phone number
• names or health details of family members, patients or anyone else
• photos or scans of bills, letters or records

Describe experience in general terms ("a family member who uses insulin"), or use the anonymous option. Before attaching a file, remove names and numbers from its text, headers and comments. If you submit something private by mistake, contact the agency contact person right away; removal is up to the agency.

When a rule takes effect first

Federal law lets an agency skip advance notice and comment when it finds "good cause." Some rules are issued as interim final rules with comment period: final in form, with comments taken at the same time or afterward, so the rule can take effect before the agency has weighed them. CMS's Medicaid community engagement rule (CMS-2454-IFC), for example, took effect July 31, 2026, the day its comment period closed.

If nothing is open on your issue, federal law gives any interested person the right to petition an agency to issue, change or repeal a rule. California law gives the same right for state regulations.

California health rules

Where proposals are announced. Formal rulemaking starts when an agency's Notice of Proposed Action appears in the California Regulatory Notice Register, which the Office of Administrative Law (OAL) publishes every Friday. The agency must also post the notice, proposed text and reasons on its website, and mail the notice to anyone who has asked. You can ask an agency to notify you of all its proposals or only those for particular programs. The California Department of Public Health, for example, keeps a "Proposed Regulations" page listing its current rulemaking files.

What to read. The Notice of Proposed Action (deadline, any hearing, contact person); the Express Terms, or proposed text, with additions underlined and deletions struck through; and the Initial Statement of Reasons, which explains why and lists the evidence relied on.

Written comments. The period must last at least 45 days. Send comments to the contact person named in the notice, by the method it gives. Do not send comments on a regular rulemaking to OAL.

Hearings. If no hearing is scheduled, any interested person can request one in writing no later than 15 days before the written comment period closes, and the agency must then hold it. Spoken and written comments are accepted at a hearing; the agency may set reasonable time limits.

Changes. If the agency makes substantial but related changes, it must allow at least 15 days for comments on those changes only, and it notifies everyone who commented or testified. Commenting once keeps you informed.

The agency's answer. Its Final Statement of Reasons must summarize and respond to each timely comment, explaining either the change made or why the comment was rejected. OAL then reviews the file, and approved regulations usually take effect on a quarterly date (January 1, April 1, July 1 or October 1) set by when they are filed, unless another date applies.

Public file. The rulemaking file, including written comments, is open to public inspection. The same privacy cautions apply.

Emergency regulations move fast. The public has 5 calendar days to comment, starting when OAL posts notice of the emergency action on its website. Send it to OAL with a copy to the agency's contact person, saying it concerns an emergency action under OAL review and naming the topic. Some agencies also take informal comments on drafts before formal notice, at their discretion.

Local meetings: city councils and county boards in California

Local bodies also decide health matters, such as public health programs and emergency services. California's open-meeting law, the Ralph M. Brown Act, covers cities, counties, school districts, special districts and their boards and commissions. Under it:

• The agenda for a regular meeting must be posted at least 72 hours ahead, including on the agency's website if it has one, with a brief description of each item and how to request a disability-related accommodation.
• The public can usually speak on an agenda item before or during its discussion, and on other matters within the body's subject area. The body generally cannot act on items not on the agenda.
• Time limits must be reasonable. A speaker using a translator gets at least twice the usual time, unless the body uses simultaneous translation.
• The body may not ban public criticism of its policies, programs or services.

Fresno example (City of Fresno, checked October 22, 2026). City Council meetings usually begin at 9:00 a.m. in the Council Chamber at City Hall, 2600 Fresno Street. Remaining 2026 dates are November 5, November 12, December 3 and December 17. To speak in person, fill out a speaker card in the chamber; to speak remotely, register for the Zoom webinar in advance and use "Raise Hand". Each speaker has up to 3 minutes. Written comments must reach the City Clerk at least 24 hours before the item is heard, by eComment or email. eComment opens when the agenda is published, closes 24 hours before the meeting starts, allows 1,440 characters, and is not accepted for land use or CEQA (environmental review) items. Emails should give the meeting date and item number. Check the city's Council Meeting Information page for changes.

For 3 minutes: name the item, make one or two points, say what you are asking for, and time yourself aloud. Meetings are streamed live, so the same privacy cautions apply.

Does commenting make a difference?

It can, within limits. Federal law requires an agency to consider the relevant material the public submits and to explain the final rule's basis and purpose. In the example notice, CMS says it will not reply to comments individually but will respond to them in the preamble (explanatory opening) of its next document on the rule. California agencies must answer each timely comment in writing.

Final rules do change. In the Transparency in Coverage final rule published October 6, 2026, the agencies say they finalized many provisions as proposed or with modifications after considering public comments, and declined to finalize some others. Comments tend to carry weight when they give the agency something it lacked: how a rule works in practice, its costs, an unintended effect, or a workable alternative.

Commenting cannot guarantee an outcome or resolve your own case. To follow a federal rule, use the "Subscribe" button on its Regulations.gov docket page. In California, watch the agency's rulemaking page and any 15-day notice of changes.

A printable health rule comment planning template walks through each step. For how agencies design and weigh public input, see Public Participation in Regulation.

Sources

1. 5 U.S.C. 553, Rule making — U.S. Code (2023 edition), U.S. Government Publishing Office, accessed October 22, 2026.
2. Frequently Asked Questions: Commenting, Privacy, Rulemaking Process, Proposed Rule Summary and Subscriptions — Regulations.gov, eRulemaking Program, General Services Administration; FAQ content versions dated 2025, accessed October 22, 2026.
3. Tips for Submitting Effective Comments — Regulations.gov, eRulemaking Program, accessed October 22, 2026.
4. Medicare Program; Implementation of Sections 6219, 6220, and 6224 of the Consolidated Appropriations Act, 2026 (proposed rule, CMS-4214-P) — Centers for Medicare & Medicaid Services, Federal Register, 91 FR 66408, October 20, 2026; accessed October 22, 2026.
5. Federal Register document 2026-21420, printed edition — U.S. Government Publishing Office, October 20, 2026.
6. Docket CMS-2026-3533 — Regulations.gov; docket and document records checked October 21–22, 2026.
7. Medicaid Program; Community Engagement Requirement for Certain Individuals (interim final rule with comment period, CMS-2454-IFC) — Centers for Medicare & Medicaid Services, Federal Register, 91 FR 33348, June 3, 2026.
8. Transparency in Coverage (final rule) — Departments of the Treasury, Labor, and Health and Human Services, Federal Register, 91 FR 63748, October 6, 2026.
9. About the Regular Rulemaking Process — California Office of Administrative Law, accessed October 21, 2026.
10. About the Emergency Rulemaking Process — California Office of Administrative Law, accessed October 21, 2026.
11. California Regulatory Notice Register — California Office of Administrative Law, accessed October 22, 2026.
12. Government Code section 11346.4 (notice of proposed action) — California Legislature, as reproduced by California.Public.Law, accessed October 22, 2026.
13. Government Code section 11346.8 (hearings, comments and changes) — California Legislature, as reproduced by California.Public.Law, accessed October 22, 2026.
14. Government Code section 11347.3 (rulemaking file) — California Legislature, as reproduced by California.Public.Law, accessed October 22, 2026.
15. Government Code section 11340.6 (petitions) — California Legislature, as reproduced by California.Public.Law, accessed October 22, 2026.
16. Proposed Regulations — California Department of Public Health, Office of Regulations, accessed October 22, 2026.
17. Government Code section 54951 (Brown Act: local agency) — California Legislature, as reproduced by California.Public.Law, accessed October 22, 2026.
18. Government Code section 54954.2 (Brown Act: agendas) — California Legislature, as reproduced by California.Public.Law, accessed October 22, 2026.
19. Government Code section 54954.3 (Brown Act: public comment) — California Legislature, as reproduced by California.Public.Law (text updated January 1, 2026), accessed October 22, 2026.
20. Council Meeting Information — City of Fresno, Office of the City Clerk, accessed October 22, 2026.