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Federal Register / Vol. 86, No. 192 / Thursday, October 7, 2021 / Rules and Regulations
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
42 CFR Part 59
RIN 0937AA11

Ensuring Access to Equitable, Affordable, Client-Centered, Quality Family Planning Services Office of the Assistant Secretary for Health, Office of the Secretary, Department of Health and Human Services HHS.
ACTION: Final rule.
AGENCY:

The Office of Population Affairs OPA in the Office of the Assistant Secretary for Health issues this final rule to revise the regulations that govern the Title X family planning program authorized by Title X of the Public Health Service Act by readopting the 2000 regulations, with several revisions to ensure access to equitable, affordable, client-centered, quality family planning services for clients, especially low-income clients.
The effect of this 2021 final rule is to revoke the requirements of the 2019
regulations, including removing restrictions on nondirective options counseling and referrals for abortion services and eliminating requirements for strict physical and financial separation between abortion-related activities and Title X project activities, thereby reversing the negative public health consequences of the 2019
regulations. OPA also makes several revisions to the 2000 regulations to increase access to equitable, affordable, client-centered, quality family planning services.
DATES: This rule is effective November 8, 2021.
FOR FURTHER INFORMATION CONTACT:
Jessica Swafford Marcella, Deputy Assistant Secretary for Population Affairs, Office of Population Affairs, Office of the Assistant Secretary for Health, Department of Health and Human Services, 200 Independence Avenue SW, Washington, DC 20201;
email: Jessica.marcella@hhs.gov.
SUPPLEMENTARY INFORMATION: As described in the 2021 Notice of Proposed Rulemaking NPRM 86 FR
19812, April 15, 2021, the Department proposed to revoke the 2019 Title X
regulations 84 FR 7714, March 4, 2019
and readopt the 2000 regulations 65 FR
41270, July 3, 2000 with 14 revisions and 10 technical corrections. Revisions were proposed to 59.2, 59.5a1, 59.5a3, 59.5a8, 59.5a9, 59.5a12, 59.5a13, 59.5b1, 59.5b3, 59.5b8, 59.6, 59.7, 59.10,
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SUMMARY:

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and 59.11. Technical corrections were proposed to 59.2, 59.5a4, 59.5a5, 59.5a6, 59.5a7, 59.5a11, 59.5b3, 59.6b2, 59.8, and 59.12.
HHS received comments on all of the revisions proposed in the NPRM, except the revision to 59.11. In addition, the Department received comments on three of the 10 technical corrections, including the technical corrections to 59.5a4, 59.5a5, and 59.12.
Based on the comments received in response to the NPRM, the Department adopts eight of the revisions initially proposed in the NPRM and nine of the technical corrections initially proposed in the NPRM as final without additional changes. This includes the revisions to 59.5a3, 59.5a8, 59.5a9, 59.5b3, 59.5b8, 59.6, 59.7, and 59.11. This also includes the technical corrections to 59.2, 59.5a4, 59.5a5, 59.5a6, 59.5a7, 59.5a11, 59.5b3, 59.6b2, and 59.8. Further, based on the comments received in response to the NPRM and a subsequent, new interpretation by the Department since the NPRM was issued, the final rule includes nine additional revisions and six additional technical corrections to what was proposed in the NPRM. The nine revisions include a additional modifications to four of the provisions initially revised in the NPRM
59.2, 59.5a1, 59.5b1, and 59.10;
b additional modifications to one of the provisions with a technical correction in the NPRM 59.5a4; c removal of three of the revised provisions in the NPRM 59.5a12, 59.5a13, and 59.12; and d revisions to one provision not originally proposed for revision in the NPRM 59.5b6.
The six additional technical corrections include minor clarifications to 59.2, 59.5a1, 59.5a4, and 59.6 and two technical corrections to 59.5b7 and 59.7 to reflect inclusive language.
Detailed descriptions of all revisions, modifications, and technical corrections are included later in this final rule. In addition to revoking the 2019 rule, this final rule includes the following revisions to the 2000 rule: Adding several new definitions; requiring sites that do not offer a broad range of contraceptive methods on-site to provide a prescription to the client for their method of choice or referrals, as requested; requiring that family planning services be client-centered, culturally and linguistically appropriate, inclusive, traumainformed, and capable of ensuring equitable and quality service delivery;
clarifying requirements around billing practices and income verification;
enabling a broader range of clinical service providers to direct family
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planning services and to provide consultation for medical services related to family planning; clarifying the intent of community education; clarifying the purpose and responsibilities of the Information and Education Advisory Committee; including referral for primary healthcare providers;
expanding the grant review criteria to address equity; including language to safeguard client confidentiality; and removing the list of other applicable regulations from the regulatory text.
The Secretary of the Department of Health and Human Services the Secretary issues the below regulations establishing requirements for recipients of family planning services grants under section 1001 of the Public Health Service PHS Act, 42 U.S.C. 300. The rules below adopt, with the modifications described above, the regulations proposed for public comment on April 15, 2021 at 86 FR
19812. They accordingly revoke the 2019 final rule, Compliance with Statutory Program Integrity Requirements, promulgated on March 4, 2019 84 FR 7714.
Table of Contents I. Background II. Public Comment and Departmental Response i. General Comments Related To Revoking 2019 Regulations and Readopting the 2000 Regulations A. Compliance With Section 1008 42
U.S.C. 300a6
B. Data on Negative Public Health Consequences of 2019 Rule C. Grantee and Subrecipient Compliance D. Application of Conscience Statutes to Title X
E. Options Counseling F. Subrecipient Nondiscrimination G. Other Comments ii. Comments Regarding Proposed Revisions and Technical Corrections to the 2000 Regulation A. 59.2. Definitions B. 59.5a1. Broad Range of Acceptable and Effective Medically Approved Family Planning Methods and Services C. 59.5a3. Services are ClientCentered, Culturally and Linguistically Appropriate, Inclusive, and TraumaInformed; Protect the Dignity of the Individual; and Ensure Equitable and Quality Service Delivery Consistent With Nationally Recognized Standards of Care D. 59.5a4. Services Do Not Discriminate Against any Client Based on Religion, Race, Color, National Origin, Disability, Age, Sex, Sexual Orientation, Gender Identity, Sex Characteristics, Number of Pregnancies, or Marital Status E. 59.5a8. Charges for Services With a Schedule of Discounts F. 59.5a9. Reasonable Measures To Verify Client Income G. 59.5a12. State Reporting Laws
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