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1 1 (June 11, 2021)

handle is hein.crs/govedqv0001 and id is 1 raw text is: Congressional Research Service Intorm~ng the legislative debate since 1914 0 June 11, 2021 Title X Family Planning Program: 2021 Proposed Rule The Title X Family Planning Program (Title X) is the only domestic federal program dedicated solely to family planning and related preventive health services. The program provides competitive grants to public and nonprofit agencies to establish and maintain family planning projects (also called Title X projects). In the April 15, 2021, Federal Register, the Department of Health and Human Services (HHS) published a proposed rule, Ensuring Access to Equitable, Affordable, Client- Centered, Quality Family Planning Services (https://go.usa.gov/xHWMb). Among other things, it would reverse several changes made by the Trump Administration's 2019 final rule currently in effect, Compliance With Statutory Program Integrity Requirements (https://go.usa.gov/xEdTp, see also CRS In Focus IF11142, Title X Family Planning Program: 2019 Final Rule). For example, Title X projects are currently prohibited from making abortion referrals; the proposed rule would restore a pre-2019 requirement that projects provide an abortion referral if requested by the client. Currently Title X projects must be physically separate from certain abortion-related activities. The proposed rule would remove this physical separation requirement that was added by the 2019 rule. Overview of the 2021 Proposed Rule This section summarizes selected regulatory changes that would be made by the 2021 proposed rule. Services for Pregnant Clients Current regulations. The 2019 rule added a new requirement that Title X projects refer all pregnant clients to medically necessary prenatal health care. Title X projects are allowed to refer pregnant clients to social services and adoption agencies, provide pregnancy health information, and provide a list of comprehensive primary health care providers, including prenatal care providers. The 2019 rule permits, but does not require, the above mentioned list to include some primary care providers who also perform abortions. Neither the list nor project staff may identify providers who perform abortions. The 2019 rule generally prohibits projects from referring patients for abortion as a method of family planning. The rule permits physicians and advanced practice providers to give nondirective pregnancy counseling, which may include nondirective counseling on abortion. Proposed rule. The proposed rule would remove the above regulatory provisions, restoring pre-2019 requirements that Title X projects offer pregnant clients information and nondirective counseling on each of these options: prenatal care and delivery; infant care, foster care, or adoption; and abortion (unless a client indicates that they do not want information or counseling about particular options). Projects would also be required to provide referrals upon client request, including abortion referrals. The preamble to the proposed rule states that individuals and grantees with conscience objections will not be required to follow the proposed rule's requirements regarding abortion counseling and referral. (The proposed rule itself does not specify this exception.) The proposed rule would also remove the restriction, added in 2019, that only physicians and advanced practice providers may provide nondirective counseling. (Thus registered nurses, for example, could potentially provide such counseling under the proposed rule.) Physical Separation from Abortion Activities By statute, Title X funds may not be used in projects in which abortion is a method of family planning, and Title X funds shall not be expended for abortions. (42 U.S.C. 300a-6; P.L. 116-260, Division H, Title II). Current regulations. The 2019 rule added a requirement that Title X projects maintain physical separation from certain prohibited activities, including providing, referring, encouraging, promoting, or advocating for abortion. For example, the rule requires separate facilities (including exam and waiting rooms, entrances and exits, and websites), staff, accounting and medical records, and workstations for these activities. Title X funds cannot be used to build infrastructure for prohibited abortion-related activities. Proposed rule. The proposed rule would remove the physical separation requirement and the infrastructure provision. Using Title X funds to provide abortion would still be prohibited by statute. Services to Minors Title X statute requires grantees to encourage family participation in minors' decisions to seek family planning services. Title X projects also must counsel minors on how to resist attempted coercion into sexual activity and must comply with all state and local laws on notification or reporting of child abuse, child molestation, sexual abuse, rape, and incest (42 U.S.C. 300(a); P.L. 116-260, Division H, Title II, §207 and §208). Current regulations. The 2019 rule added a requirement that projects conduct a preliminary screening of any minor client with a sexually transmitted disease, pregnancy, or any suspicion of abuse in order to rule out victimization. The rule also added new documentation requirements: certain minors' medical records must indicate their sexual partners' nttps://crsreport

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