2021 Title X Final Rule: Summary of Revisions and Technical Corrections in the 2021 Rule Compared to the 2000 Rule


Revisions and Technical Corrections in 2021 Title X Final Rule Compared to 2000 Regulatory Text


  • Includes revised definition of family planning to align with Providing Quality Family Planning Services Recommendations (QFP)
  • Includes revised definition of service site
  • Includes new definitions for adolescent-friendly health services; client-centered care; clinical services provider; culturally and linguistically appropriate services; health equity; inclusive; quality healthcare; and trauma-informed
  • Includes technical corrections to (1) change “recipient” to “grantee” within definition of service site and (2) change FDA-approved contraceptive “services” to “products” within definition of family planning


  • Defines broad range of methods and services
  • Includes technical correction to clarify referral requirement is “a prescription to the client for their method of choice or referrals to another provider, as requested.”


  • Includes requirement that services be client-centered, culturally and linguistically appropriate, inclusive, trauma-informed; and ensure equitable and quality services delivery


  • Includes technical corrections to (1) change “handicapped condition” to “disability”, (2) change “without regard of” to “provides services in a manner…”, and (3) change “sex” to “sex, sexual orientation, gender identity, and sex characteristics”


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


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


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



  • Incorporates client income verification from the 2014 Title X Program Requirements
  • Adds requirement to use client self-reported income after reasonable attempts to verify income


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


  • Expands consultation for medical services beyond a physician to a “clinical services provider”
  • Clarifies services provided in person or via telehealth


  • Specifies 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
  • Includes a technical correction to clarify “opportunities for community education, participation, and engagement”


  • Expands 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”


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


  • Includes primary healthcare providers in list of referrals
  • Specifies 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”


  • Consolidates all Information and Education Advisory Council requirements together under one provision
  • Confirms that the requirements for the Advisory Council apply to both print and electronic materials, expands the upper limit of the number of people that can be on the Advisory Council, expands the composition of the Advisory Council, and expands the function of the Advisory Council
  • Includes technical corrections to change “handicapped condition” to “disability” and to include “sex characteristics” in the list of demographic factors to consider when determining composition of the Advisory Council


  • Adds one additional grant review criteria to assess how the project will advance equity
  • Includes technical correction to change “his” to “an”


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


  • Includes practice from the 2014 Title X Program Requirements that reasonable efforts must be made to collect charges without jeopardizing client confidentiality
  • Adds new requirement that clients must be informed of any potential for disclosure of their confidential health information to policyholders where the policyholder is someone other than the client
  • Adds 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)


  • Adds “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"