HeinOnline is a subscription-based resource containing thousands of academic and legal journals from inception; complete coverage of government documents such as U.S. Statutes at Large, U.S. Code, Federal Register, Code of Federal Regulations, U.S. Reports, and much more. Documents are image-based, fully searchable PDFs with the authority of print combined with the accessibility of a user-friendly and powerful database. For more information, request a quote or trial for your organization below.
![handle is hein.crs/goveguo0001 and id is 1 raw text is: Updated November 10,2021
Title X Family Planning Program: 2019 Final Rule
The Title X Family Planning Program(Title X) is the only
domestic federalprogramdevoted solely to family planning
and related preventive health services. The program
provides grants to public and nonprofit agencies to establish
and maintain family planning projects (Title Xprojects). A
Title X grantee can undertake a Title X project that has
severalparticipating entities. For example, a state-agency
grantee canhave a Title X project that supports the state's
localorganizations and clinics.
In the March 4, 2019 Federal Register, the Department of
Health and Human Services (HHS) published a fmalrule
for the program, https://go.usa.gov/xEdTp. Among other
things, it prohibited Title Xprojects fromreferring clients
for abortion as a method of family planning. It also requiied
physical separationbetween Title X projects and certain
abortion-related activities. For a redline document showing
how the rule changed prior regulations, see
https://go.usa.gov/xAFQA.
On October 7, 2021, HHS published a new fmalrule in the
Federal Register, https://go.usa.gov/xMfQy. Effective
November 8, 2021, the new rule, among other things,
revokes the 2019 rule in its entirety andlargely reinstates
the program's pre-2019 guidance and regulations. This In
Focus summarizes the 2019rule and may be ofhistorical
interest.
Overview of the 20 19 Final Rule
HHS required compliance with the 2019 final rule starting
July 15, 2019, except for the physical separation
requirements, for which compliance was required by March
4, 2020. The rule was challenged in severallawsuits across
the country, but eventually tookeffect in all states except
Maryland, where it was enjoined. This section summarizes
selected regulatory changes made by the2019 rule.
Family Planning Definition
Prior regulation. Family planning was not defined.
2019 rule. Therule introduced a new definitionoffamily
planning, referring to it as the voluntary process of
identifying goals and developing a plan for the number and
spacingofchildren andthemeans bywhich thosegoals
may be achieved. Family planning could include, among
other things, an array of acceptable and effective choices,
which may range from choosing not to have sexto the use
of other family planning methods and services to limit or
enhance thelikelihood of conception (including
contraceptive methods and natural family planning or other
fertility awareness-based methods) and the management of
infertility (including adoption).
Scope of Family Planning Services
Prior regulation. Title X projects were required
to [p]rovide abroad range of acceptable and effective
medically approved family planning methods (including
natural family planning methods) and services (including
infertility services and services for adolescents). If a health
care entity offers only a single method of family planning,
it may participate as part of a project as long as the entire
project offers a broadrangeoffamily planning services.
2019 rule. Therule required Title X projects to [p]rovile a
broad range of acceptable andeffective family planning
methods (including contraceptives, natural family planning
or other fertility awareness-based methods) and services
(including infertility services, information aboutor referrals
for adoption, and services for adolescents). The rule did
not require family planning methods and services to be
medically approved. The rule did not require Title X
projects to provide every acceptable and effective family
planning method or service. The rule statedthat [a]
participating entity may offer only a single method or a
limited numberofmethods of family planning as long as
the entire project offers a broad range of such family
planning methods and services.According to its preamble,
the rule allowed participation by clinics that, for reasons of
conscience, limit the services they offer.
Physical and Financial Separation
By law, Title X funds may not beusedin projects where
abortion is a method of family planning (42 U.S.C. 300a-6).
Prior guidance. Programguidance interpreted the law as
requiring that a grantee's abortion activities be separate
and distinct fromits Title X project activities. Underprior
guidance, a grantee's abortion activities and its Title X
project activities could share a common facility, a common
waiting room, common staff, and a common records
system, so long as it is possible to distinguishbetween the
Title X supported activities and non-Title X abortion-
related activities, for example, through allocating and
prorating costs, seehttps://go.usa.gov/xEdtA.
2019 rule. Therule required Title Xprojects to be
physically andfinancially separatefromprohibited
activities, including providing, referring, encouraging,
promoting, or advocating for abortion. The rule required,
for example, separate facilities (including examand waiting
rooms, entrances and exits, and websites), separate staff,
separate accounting and medical records, and separate
workstations. Title X funds could not be used to build
infrastructure for prohibited abortion-related activities. The
preamble to the rule stated that abortion-providing
organizations could still apply for and receive Title X
grants,providedthey complied with thephysical and
rre~sionn) Hesi](ViewImageLocal?handle=hein.crs/goveguo0001&div=1&collection=&method=preview&ext=.png&size=3)