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Updated March 28, 2019
Title X Family Planning Program: 2019 Final Rule
Introduction
On March 4, 2019, the Secretary of the Department of
Health and Human Services (HHS) published a final rule on
the Title X Family Planning Program (Title X) in the
Federal Register (https://go.usa.gov/xEdTp). The rule
changes, among other things, how family planning projects
(Title X projects) provide family planning methods and
services to clients.
The Family Planning Services and Population Research Act
of 1970 (P.L. 91-572, as amended) established the Family
Planning Program under Title X of the Public Health
Service Act. Administered by HHS, Title X provides grants
to public and nonprofit agencies to establish and maintain
Title X projects. Title X is the only domestic federal
program devoted solely to family planning and related
preventive health services. In 2017, the program served 4
million clients through 3,858 Title X clinics. Congress
appropriated $286.5 million to the program for FY2019.
Overview of the New Rule
This section summarizes selected regulatory changes made
by the final rule.
Family Planning Definition
Prior regulation. Prior regulations did not define family
planning.
New regulation. The final rule introduces a new definition
of family planning, referring to it as the voluntary process
of identifying goals and developing a plan for the number
and spacing of children and the means by which those goals
may be achieved. Family planning can include, among
other things, a range of acceptable and effective choices,
which may range from choosing not to have sex to the use
of other family planning methods and services to limit or
enhance the likelihood 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
A Title X grantee can undertake a Title X project that has
several participating entities, organizations, and/or clinics.
A grantee that is a state agency, for example, can have a
Title X project that supports local entities, organizations,
and clinics throughout the state.
Prior regulation. Prior regulations required Title X
projects to[p]rovide a broad 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 broad range of family planning
services.
New regulation. The new rule does not require family
planning methods and services to be medically approved.
The rule also does not require Title X projects to provide
every acceptable and effective family planning method or
service. In addition, the rule does not change the
abovementioned criterion for participation. According to
the rule's preamble, the rule allows participation by clinics
that, for reasons of conscience, limit the services they
offer.
Physical and Financial Separation
Prior guidance. By law, Title X funds may not be used for
abortion. Prior program guidance interpreted the law as
requiring that a grantee's abortion activities be separate
and distinct from its Title X project activities. Under prior
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 distinguish between the
Title X supported activities and non-Title X abortion-
related activities, for example through allocating and pro-
rating costs (https://go.usa.gov/xEdtA).
New regulation. The new rule requires Title X projects to
be physically and financially separate from prohibited
activities, including providing, referring, encouraging,
promoting, or advocating for abortion. The rule requires,
for example, separate facilities (including exam and waiting
rooms, entrances and exits, and websites), separate staff,
separate accounting and medical records, and separate
workstations. Title X funds cannot be used to build
infrastructure for prohibited abortion-related activities.
The preamble to the final rule states that abortion-providing
organizations may still apply for and receive Title X grants,
provided they comply with the physical and financial
separation requirements, and other Title X requirements.
Referrals to Primary Care
Prior regulation. Prior regulations required Title X
projects to provide for coordination and use of referral
arrangements with other health care providers.
New regulation. The new rule encourages Title X projects
to offer either comprehensive primary health services
onsite or have a robust referral linkage with primary health
providers who are in close physical proximity, to the Title
X site.
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