Understanding Title X Program Expectations in 2021

Level Setting: 2021 Title X Program Expectations April 19, 2023

Facilitator Angie Fellers LeMire, MSN, TTA Provider, RHNTC

2021 Title X Expectations Went into effect on November 4, 2021 Repealed 2019 regulations, readopted 2000 regulations with revisions Reinforce central tenets of equity, quality, and access for all who seek Title X services Modernize the Title X Program

Key Provisions Pregnancy options counseling and referrals Separation of family planning and abortion services Confidentiality Clinical services providers

Pregnancy Options Counseling and Referrals Staff must provide pregnancy options counseling. Title X providers are required to provide neutral, factual information and nondirective counseling and referral upon request on each of these options: A. Prenatal care and delivery B. Infant care, foster care, or adoption C. Pregnancy termination 65 Fed. Reg. 41281 (July 3, 2000) | 42 CFR 59.5(a)(5)

Referral Resources for Options Counseling RHNTC s Establishing and Providing Effective Referrals for Clients: A Toolkit for Family Planning Providers Includes: Nondirective Counseling and Referral Job Aid Nondirective Counseling and Referral Sample Policy Template Sample MOU Template

Separation of Services 1 Title X recipients are required to ensure that non-Title X abortion activities are separate and distinct from Title X project activities. Where recipients conduct abortion activities that are not part of the Title X project and would not be permissible if they were, the recipient must ensure that the Title X-supported project is separate and distinguishable from those other activities. 65 Fed. Reg. 41281 (July 3, 2000)

Separation of Services 2 Separation of Title X from abortion activities does not require separate recipients or even a separate health facility. However, separate bookkeeping entries alone will not satisfy the spirit of the law. Mere technical allocation of funds, attributing federal dollars to non-abortion activities, is not a legally supportable avoidance of section 1008. 65 Fed. Reg. 41281 (July 3, 2000)

Separation of Services 3 Certain kinds of shared facilities are permissible, so long as it is possible to distinguish between the Title X-supported activities and non-Title X abortion-related activities: Common waiting room Common staff A hospital offering abortions for family planning purposes and also housing a Title X project Maintenance of a single file system for abortion and family planning patients 65 Fed. Reg. 41281 (July 3, 2000)

Confidentiality Protections 1 Reaffirms that information about individuals receiving services must be held confidential and must not be disclosed without the individual's documented consent, except as may be necessary to provide services to the patient or as required by law, with appropriate safeguards for confidentiality. 42 CFR 59.10

Confidentiality Protections 2 Reaffirms it is unallowable to: Require consent of parents/guardians in order to provide Title X services to minors Notify parents/guardians before or after minors request/receive services 42 CFR 59.10

Clinical Services Providers 1 Expanded to allow family planning medical services to be performed under the direction of a clinical services provider, with services offered within their scope of practice and allowable under state law instead of physician

Clinical Services Providers 2 Title X providers must: Ensure that family planning medical services will be performed under the direction of a clinical services provider, with services offered within their scope of practice and allowable under state law, and with special training or experience in family planning. Provide for medical services related to family planning including consultation by a clinical services provider. 42 CFR 59.5(b)

Questions?

rhntc.org THANK YOU! CONTACT US rhntc@jsi.com This webinar was supported by the Office of Population Affairs (Grants FPTPA006030, TPSAH000006). The views expressed do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

References 1 Code of Federal Regulations. (2021, October 7). eCFR :: 42 CFR Part 59 Subpart A Project Grants for Family Planning Services. National Archives. https://opa.hhs.gov/grant-programs/title-x-service-grants/title-x-statutes-regulations- and-legislative-mandates/2021-0 Department of Health and Human Services. (2021). 2021 Title X Final Rule SUMMARY. https://opa.hhs.gov/sites/default/files/2021-10/2021-Title-X-Final-Rule- One-Pager-October-2021.pdf Office of Population Affairs. (2021). 2021 Title X Final Rule: Summary of Revisions and Technical Corrections in the 2021 Rule Compared to the 2000 Rule. https://opa.hhs.gov/grant-programs/title-x-service-grants/title-x-statutes-regulations- and-legislative-mandates/2021-0

References 2 Department of Health and Human Services. (2000, July 3). Provision of Abortion- Related Services in Family Planning Services Projects. Federal Register Volume 65, Issue 128. https://www.govinfo.gov/app/details/FR-2000-07-03/00-16759/summary Office of Population Affairs. (2022, June). Dobbs v. Jackson Women's Health Organization U.S. Supreme Court Decision: Impact on Title X Program: QUESTIONS & ANSWERS FOR TITLE X RECIPIENTS. https://content.govdelivery.com/attachments/USHHSOPA/2022/06/29/file_attachment s/2197691/dobbs-decision-faqs-title-x-recipients-june-2022.pdf