2021 Title X Final Rule: Summary of Revisions and Technical Corrections in 2021 Notice of Proposed Rulemaking (NPRM) Compared to 2000 Regulations and 2021 NPRM Compared to 2021 Final Rule

Provision

Revisions and Technical Corrections Proposed to 2021 NPRM Compared to 2000 Regulations

Additional Revisions & Technical Corrections to 2021 Final Rule Compared to 2021 NPRM

59.2

  • Included revised definition of family planning to align with Providing Quality Family Planning Services Recommendations (QFP)
  • Included revised definition of service site
  • Added definitions for adolescent-friendly health services; client-centered care; culturally and linguistically appropriate services; health equity; inclusive; quality healthcare; and trauma-informed
  • Included technical correction to change “grantee” to “recipient” within definition of service site

Revision & technical correction

  • Added definition for clinical services provider
  • Included technical correction to change FDA-approved “services” to “products” within the definition of family planning

Adopted technical correction from NPRM as final

Additional revision & technical correction from NPRM

59.5(a)(1)

  • Defined broad range of methods and services
  • Added requirement for sites that didn’t offer broad range of methods to refer clients for their method of choice and stated that the referral could not unduly burden the client

Revision

  • Removed “undue burden” standard for referrals
  • Included technical correction to clarify referral requirement is “a prescription to the client for their method of choice or referrals to another provider, as requested.”

Additional revision & technical correction from NPRM

59.5(a)(3)

  • Required services to be client-centered, culturally and linguistically appropriate, inclusive, trauma-informed; and ensure equitable and quality services delivery

Revision

Adopted revision from NPRM as final

 

59.5(a)(4)

  • Included technical correction to change “handicapped condition” to “disability”

Technical correction

  • Adopted technical correction and further revised to “provides services in a manner…” instead of “without regard of”
  • Included technical correction to change “sex” to “sex, sexual orientation, gender identity, sex characteristics”

Adopted technical correction from NPRM as final

Additional revision & technical correction from NPRM

59.5(a)(5)

  • Included technical correction to change “women” to “client”

Technical correction

 

Adopted technical correction from NPRM as final

 

59.5(a)(6)

  • Included technical correction to change “persons” to “clients”

Technical correction

Adopted technical correction from NPRM as final

 

59.5(a)(7)

  • Included technical correction to change “persons” to “clients”

Technical correction

Adopted technical correction from NPRM as final

 

59.5(a)(8)

Revision

Adopted revision from NPRM as final

59.5(a)(9)

Revision

Adopted revision from NPRM as final

59.5(a)(11)

  • Included technical correction to change “subgrantees” to “subrecipients”

Technical correction

Adopted technical correction from NPRM as final

 

59.5(a)(12)

  • Revised to retain some State mandatory reporting requirements from 2019 regulations

Revision

Additional revision from NPRM - Removes provision from final rule

59.5(a)(13)

  • Revised to retain some subrecipient monitoring requirements from 2019 regulations

Revision

Additional revision from NPRM - Removes provision from final rule

59.5(b)(1)

  • Revised to allow consultation for medical services beyond a physician to broader “healthcare providers”

 

Revision

  • Revised “healthcare providers” to “clinical services provider” using definition from FPAR
  • Added services provided via telehealth

Additional revision from NPRM

59.5(b)(3)

  • Specified continued participation in the project by diverse individuals to make services accessible and clarifies that the intent of their participation is to ensure access to equitable, affordable, client-centered, quality family planning services
  • Included a technical correction to clarify “opportunities for community education, participation, and engagement”

Revision & technical correction

Adopted revision and technical correction from NPRM as final

59.5(b)(6)

No revisions proposed in NPRM

  • Revised to have family planning medical services 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”

Additional revision from NPRM

59.5(b)(7)

No revisions proposed in NPRM

  • Includes technical correction to change “his” to “their”

Additional technical correction from NPRM

59.5(b)(8)

  • Included primary healthcare providers in list of referrals
  • Clarified that referrals and linkages to other providers “who are in close physical proximity to the Title X site, when feasible, in order to promote access to services and provide a seamless continuum of care”

Revision

 

Adopted revisions from NPRM as final

 

59.6

  • Consolidated all Information and Education Advisory Council requirements together under one provision
  • Clarified that the requirements for the Advisory Council apply to both print and electronic materials, expanded the upper limit of the number of people that can be on the Advisory Council, expanded the composition of the Advisory Council, and expanded the function of the Advisory Council
  • Included a technical correction to change “handicapped condition” to “disability”

Revision & technical correction

  • Includes a technical correction to add sex characteristics to the list of demographic factors to consider when determining composition of the Advisory Council

Adopted revision and technical correction from NPRM

Additional technical correction from NPRM

59.7

  • Added one additional grant review criteria to assess how the project will advance equity

Revision

  • Included a technical correction to change “his” to “an”

Adopted revision from NPRM as final

Additional technical correction from NPRM

59.8

  • Included technical correction to change “project period” to “anticipated period”

Technical correction

Adopted technical correction from NPRM as final

59.10

  • Included practice from the 2014 Title X Program Requirements - PDF that reasonable efforts must be made to collect charges without jeopardizing client confidentiality
  • Added new requirement that grantees must inform the client of any potential for disclosure of their confidential health information to policyholders where the policyholder is someone other than the client

Revision

  • Added adolescent confidentiality protections that were previously included in OPA Program Policy Notice 2014-01—Confidential Services to Adolescents
  • To the extent practical, Title X projects shall encourage family participation.[1] However, Title X projects may not require consent of parents or guardians for the provision of services to minors, nor can any Title X project staff notify a parent or guardian before or after a minor has requested and/or received Title X family planning services

    [1] 42 U.S.C. § 300(a)

    Additional revision from NPRM

59.11

  • Added “during” the period of the award to allow for imposition of additional conditions, during the period of award in addition to “prior to and at the time of any award”

Revision

Adopted revision from NPRM as final

59.12

  • Included a technical correction to revise other regulations that apply

Technical correction

Additional revision from NPRM - Removes provision from final rule