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![handle is hein.crs/goveexw0001 and id is 1 raw text is: Congressional Research Service
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December 7, 2021
Title X Family Planning Program: 2021 Final 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 October 7, 2021, Federal Register, the Department of
Health and Human Services (HHS) published a final rule,
Ensuring Access to Equitable, Affordable, Client-
Centered, Quality Family Planning Services (see
https://go.usa.gov/xMfQy). Among other things, it revokes
the Trump Administration's 2019 final rule, Compliance
With Statutory Program Integrity Requirements (see
https://go.usa.gov/xEdTp; see also CRS In Focus IF11142,
Title X Family Planning Program: 2019 Final Rule). The
2021 final rule, effective November 8, 2021, largely
reinstates regulations that were in effect prior to 2019, with
some revisions (see https://go.usa.gov/xM6Cx).
Title X's FY2022 competitive grant announcement requires
applicants to comply with the new rule. Projects are
anticipated to start on April 1, 2022 (see https://go.usa.gov/
xMHVq).
Several states seek to halt the rule's implementation. (Ohio
v. Becerra, U.S. District Court for the Southern District of
Ohio, case no. 1:21-cv-675, https://go.usa.gov/xenXG.)
Overview of the 2021 Final Rule
This section summarizes selected regulatory changes made
by the 2021 final rule.
Services for Pregnant Clients
2019 rule. The 2019 rule added a new requirement that
Title X projects refer all pregnant clients to medically
necessary prenatal health care. Projects could 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 allowed, but did not
require, the above-mentioned list to include some primary
care providers who also perform abortions. Neither the list
nor the project staff could identify providers who perform
abortions. The 2019 rule generally prohibited projects from
referring patients for abortion as a family planning method.
The rule permitted physicians and advanced practice
providers to give nondirective pregnancy counseling, which
could include nondirective counseling on abortion.
2021 rule. The 2021 rule revokes the above 2019
regulatory provisions, restoring pre-2019 requirements that
Title X projects offer pregnant clients information and
nondirective counseling on each of the following options:
prenatal care and delivery; infant care, foster care, or
adoption; and abortion (unless clients indicate they do not
want such information or counseling). Projects are required
to provide referrals upon client request, including abortion
referrals.
A footnote in the 2021 rule notes, [p]roviders may
separately be covered by federal statutes protecting
conscience. The 2021 rule's preamble states, objecting
individuals and grantees will not be required to counsel or
refer for abortions in the Title X program in accordance
with applicable federal law.
The 2021 rule removes the restriction, added in 2019, that
only physicians and advanced practice providers may
provide nondirective counseling. (Thus registered nurses,
for example, can potentially provide such counseling.)
Physical Separation from Abortion Activities
By statute, Title X funds may not be used in projects where
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.)
2019 rule. The 2019 rule added a requirement that Title X
projects maintain physical separation from certain
prohibited activities, including providing, referring clients
to, encouraging, promoting, or advocating for abortion. For
example, the rule required separate facilities, staff, and
accounting and medical records for these activities. Title X
funds could not be used to build infrastructure for
prohibited abortion-related activities.
2021 rule. The 2021 rule removes the physical separation
requirement and the infrastructure provision. It restores pre-
2019 guidance that grantees' Title X project activities and
their non-Title-X abortion activities be separate and
distinct; they may share a facility, staff, and records
system so long as it is possible to distinguish between the
Title X supported activities and non-Title X abortion-
related activities, for example, through allocating and
prorating costs (see https://go.usa.gov/xMHQ9).
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,
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