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From Health Reform WK-EDGE, March 13, 2019

HHS firm on ensuring no Title X funds go towards abortion

By Matt Pavich, J.D.

A final HHS rule cements prohibition on use of Title X funds for abortion and prohibits referral for abortions.

HHS has issued a final rule revising the governing regulation of the Title X family planning program and ensuring compliance with the statutory prohibition against the use of Title X funds in programs where abortion is a method of family planning. Under the final rule, the Office of Population Affairs (OPA) will amend the regulations to strip the requirement for nondirective abortion counseling and referral and will prohibit abortion referrals (Final rule, 84 FR 7714, March 4, 2019).

Clear separation between Title X and abortion. The Title X program funds approximately 90 public health departments and community health, family planning, and other private nonprofit agencies, supports family planning services at almost 4,000 service sites, and serves approximately 4 million individuals. The final rule requires clear financial and physical separation between Title X funded projects and programs or facilities where abortion is a method of family planning in order to ensure that Title X funding does not support those programs. HHS says this will provide needed clarity for Title X clinics and the public alike regarding permissible and impermissible activities for Title X projects.

Program transparency. With an eye towards improving program transparency, the final rule requires Title X grant applicants to include in their applications a list of all planned subrecipients, descriptions of the extent of services and collaboration with subrecipients, and a clear explanation of oversight of those subrecipients. Subrecipients are defined as any entity providing family planning services with Title X funds under a written agreement with a grantee or another subrecipient. Grantees must regularly report and demonstrate compliance and the compliance of their subrecipients.

Referral prohibition and counseling. The 2000 regulations require Title X projects to provide abortion referral and nondirective counseling on abortion upon request. The final rule revokes that requirement and finalizes the prohibition against using Title X funds to refer abortion as a method of family planning, or to perform, promote, or support it as a method of family planning. HHS believes that both abortion referrals and abortions themselves are so linked that a referral renders a Title X project or clinic as one where abortion is a method of family planning, contrary to the prohibition against the use of Title X funds in such programs.

The new regulations will no longer require pregnancy counseling, but under the final rule, funds can be used for nondirective pregnancy counseling, defined as the meaningful presentation of options without urging one option over another. HHS states that the new rule will protect Title X healthcare providers who do not wish to offer abortion counseling and referral.

Reporting requirements. The final rule is also intended to protect victims of child abuse, child molestation, incest, sexual abuse, rape, intimate partner violence, and trafficking. The 2000 regulations do not impose a federal obligation on Title X grantees and subrecipients to comply with state reporting or notification requirements on these crimes, but under the final rule, providers must comply with all state and local laws regarding notification It also requires grantees and subrecipients to have an implementation plan in place and annual training for all personnel regarding the requirements. Clinics must also have a site-specific protocol in place to protect victims/survivors of sexual assault.

The rule also clarifies that individuals may be considered for Title X services if they are unable to obtain employer-sponsored insurance coverage for certain contraceptive services due to their employer’s religious beliefs.

FederalRegisterIssuances: FinalRules AccessNews AgencyNews ContraceptionCoverageNews ReportingTransparencyNews

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