2. OPA Program Policy Notice 2024-02—Implementing Quality Family Planning Services Recommendations within Title X Projects

OPA Program Policy Notice 2024-02—Implementing Quality Family Planning Services Recommendations within Title X Projects

Release Date: November 19, 2024
OPA Program Policy Notice: 2024 – 02

Purpose

The purpose of this Program Policy Notice (PPN) is to clarify OPA expectations for Title X grant recipients implementing Providing Quality Family Planning Services in the United States: Recommendations of the U.S. Office of Population Affairs (Revised 2024) (QFP) within their Title X projects and to outline where specific QFP recommendations are outside of the scope of the Title X project. This PPN applies to Title X grant recipients, subrecipients, and service sites.

Background

Title X projects must comply with requirements set out in the Title X statute (42 U.S.C. §300 et seq.), any legislative mandates included in annual HHS appropriations (e.g., Further Consolidated Appropriations Act, 2024 (Pub. L. No. 118-47)), Title X implementing regulations at 42 CFR Part 59, Subpart A, and any applicable court orders.

The Title X regulations specify that Title X projects must provide services in a manner that “ensures equitable and quality service delivery consistent with nationally recognized standards of care” (42 CFR § 59.5(a)(3)). Providing Quality Family Planning Services in the United States: Recommendations of the U.S. Office of Populations Affairs (Revised 2024) is an update to the QFP recommendations originally published by OPA and the Centers for Disease Control and Prevention (CDC) in 2014, and it is a nationally recognized standard of care for providing quality sexual and reproductive health (SRH) services for people of reproductive age.

Although the audience for both the 2014 and 2024 QFPs include, but are not limited to, providers funded by the Title X program, a key difference between the 2014 QFP and the 2024 QFP is the scope. The 2014 QFP recommendations were more focused on the type of family planning services provided in Title X projects. The 2024 QFP recommendations, in contrast, are broader than the provision of Title X family planning services, and also include recommendations for providing additional quality sexual and reproductive health services. With respect to Title X-funded providers, where the scope of the 2024 QFP recommendations is broader than Title X family planning services and may conflict with the Title X statute, legislative mandates, regulations, or court orders, the Title X requirements control.

The Title X regulations can be found in their entirety at: eCFR :: 42 CFR Part 59 Subpart A -- Project Grants for Family Planning Services. Many requirements from the Title X regulations are directly relevant to the recommendations provided in the QFP. The QFP is a nationally recognized standard of care when implementing the Title X requirements.

QFP and Title X

Because the 2024 QFP recommendations are broader than Title X requirements, it is important to distinguish which QFP recommendations are beyond the scope of the Title X project and cannot be provided using Title X funding. A non-exclusive list of QFP recommendations which are beyond the scope of Title X, with corollary requirements that are within the scope of Title X, is set out below.

  • The provision of abortion and certain abortion-related activities are beyond the scope of Title X. Title X funds cannot be expended for abortions (Further Consolidated Appropriations Act, 2024 (Pub. L. No. 118-47, 138 Stat. 460, 652)); see also Section 1008, Public Health Service Act (42 U.S.C. §300a-6) (prohibiting Title X grant recipients from providing abortion as a method of family planning as part of the Title X project); 42 CFR § 59.5(a)(5). This prohibition applies not only to the performance of abortion by a Title X project, but also to the conduct of certain abortion-related activities by the project. For interpretations and policies relating to the Title X statutory abortion prohibition, including on abortion counseling and referral, advocacy activities, and separation, see https://opa.hhs.gov/sites/default/files/2022-02/provision-abortion-related-services-family-planning-july-3-2000.pdf. However, Title X projects are required to provide non-directive options counseling and referral, including on pregnancy termination (Further Consolidated Appropriations Act, 2024 (Pub. L. No. 118-47, 138 Stat. 460, 652); 42 CFR § 59.5(a)(5)).
  • Medically assisted reproduction services are beyond the scope of Title X. However, Title X grant recipients are required to provide basic infertility services (Section 1001(a), Public Health Service Act (42 U.S.C. §300(a)); 42 CFR § 59.5(a)(1)) and should establish referrals to providers for medically assisted reproduction services for people who need them.
  • Prenatal care is beyond the scope of Title X. However, Title X projects are required to provide non-directive options counseling and referral, including on prenatal care and delivery (42 CFR §59.5(a)(5)), and should offer STI testing and treatment at the time of pregnancy diagnosis. Title X projects are expected to follow the QFP recommendations on prenatal counseling for people who indicate that they want to continue a pregnancy as a nationally recognized standard of care.
  • Specific gender-affirming care, such as gender-affirming hormone therapy, transition services, and gender affirmation surgery is beyond the scope of Title X. However, Title X projects are expected to provide gender-inclusive sexual and reproductive health care for all clients, regardless of their gender identity. Title X providers should establish referrals for these services for people who need them.
  • Therapeutic options for perimenopausal care are beyond the scope of Title X. Title X providers should offer basic guidance and counseling related to perimenopausal symptoms and management and should establish referrals for therapeutic options for people who need them.
  • Treatment for hypertension, diabetes, mental health, and alcohol and other substance abuse is beyond the scope of Title X. However, Title X providers are expected to follow the QFP recommendations for screening and counseling for hypertension, diabetes, mental health, and alcohol and other substance abuse, and should establish referrals for people who need treatment.

As noted above, with respect to Title X projects, where recommendations in QFP may conflict with the Title X statute, legislative mandates, regulations, or court orders, the Title X requirements control.

Guidance

Title X projects must provide services in a manner that “ensures equitable and quality service delivery consistent with nationally recognized standards of care” (42 CFR § 59.5(a)(3)). Providing Quality Family Planning Services in the United States: Recommendations of the U.S. Office of Populations Affairs (Revised 2024) is a nationally recognized standard of care for services within the scope of the Title X program and for providing quality sexual and reproductive health (SRH) services for people of reproductive age.

The audience for QFP is broader than Title X-funded providers and there are several QFP recommendations, including, but not limited to, those outlined above that are beyond the scope of the Title X program. Title X grant recipients may not use their Title X funding to provide services that are beyond the scope of the Title X program. To facilitate access to those services, Title X grant recipients may provide those services through other sources of funding. Title X grant recipients can also support clients with referrals to another provider to ensure access to care.