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Federal Register / Vol. 86, No. 192 / Thursday, October 7, 2021 / Rules and Regulations
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Department has created to support and reinforce the programs statutory obligation to prioritize services to persons from low-income families. In conclusion, the Department adopts the language from the NPRM for 59.5a9
as final without revisions.
59.5a12. State Reporting Laws In the NPRM, the Department proposed adding 59.5a12 to retain some, but not all, language from the 2019 rule on notification or reporting of child abuse, child molestation, sexual abuse, rape, incest, intimate partner violence, or human trafficking. The NPRM language stated, Title X projects shall comply with all State and local laws requiring notification or reporting of child abuse, child molestation, sexual abuse, rape, incest, intimate partner violence or human trafficking collectively, State notification laws.
Title X projects must provide appropriate documentation or other assurance satisfactory to the Secretary that it: i Has in place and implements a plan to comply with State notification laws. ii Provides timely and adequate annual training of all individuals whether or not they are employees serving clients for, or on behalf of, the project regarding State notification laws;
policies and procedures of the Title X
project and/or for providers with respect to notification and reporting of child abuse, child molestation, sexual abuse, rape, incest, intimate partner violence and human trafficking; appropriate interventions, strategies, and referrals to improve the safety and current situation of the patient; and compliance with State notification laws.
Comments: Many comments supported the elimination of section 59.17 from the 2019 rule. Comments supported eliminating the 2019 rules attempt to give HHS substantial oversight over compliance with complex state reporting requirements.
Many comments noted that professionals providing services in Title X-funded sites are aware of their reporting obligations, already receive training on them, and make reports in compliance with these requirements.
Other comments stressed that determining compliance with state reporting laws lies with state authorities and noted that state reporting laws are complex and vary widely from state to state.
One comment written in opposition to the NPRM expressed that the NPRM
excluded the mandatory reporting of sex trafficking and violence by intimate partners. Another comment requested that the 2019 Title X requirement for mandatory reporting be kept fully intact.

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Another comment expressed concern that the proposed rule did not include the minor age record-keeping requirements and made an assertion that this lack of record keeping serves to enable sex traffickers and abusers to continue undetected in their abuse.
The comment proposed reinstatement of these requirements and further proposed rescinding the funding of any grant recipient who fails to screen for and report sexual abuse or sex trafficking.
Response: The Department agrees with comments that all Title X
recipients must follow state reporting laws and must comply with mandatory reporting requirements regarding child abuse, child molestation, sexual abuse, rape, or incest. The Department disagrees with the assertion that . . .
lack of record keeping serves to enable sex traffickers and abusers to continue undetected in their abuse. States have already established specific guidelines on the details that must be included in mandatory reports. As such, the Department believes that it is not necessary to impose this additional reporting burden through Title X
regulations.
Since 1999, Congress has required, through the annual appropriations bill that, notwithstanding any other provision of law, no provider of services under Title X of the PHS Act shall be exempt from any State law requiring notification or the reporting of child abuse, child molestation, sexual abuse, rape, or incest. All requirements in the appropriations riders are legislative mandates for the Title X program and all Title X grantees must comply with them. The Department will continue to enforce and monitor grantee compliance with all Title X statutory requirements and legislative mandates, including the mandate that no provider of services under Title X of the PHS Act shall be exempt from any State law requiring notification or the reporting of child abuse, child molestation, sexual abuse, rape, or incest.
As noted above with respect to Section II. C. Grantee and Subrecipient Compliance, OPA explicitly states in NOFOs that all Title X grantees must comply with the Title X statute, regulations, and legislative mandates. In addition, Title X applicants certify in the application materials that they will comply with federal law, and compliance with federal law, and compliance with program statutes and appropriations act requirements is also included as a standard term of the Title X grant award. Therefore, during the application process as well as by accepting funds, grantees have assured
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their compliance to the statute, regulations, and legislative mandates.
Furthermore, OPA includes the legislative mandates in its grantee orientation and trainings and regularly monitors grantee compliance with the legislative mandates through grantee reporting and compliance monitoring visits. OPA has consistently documented compliance with this mandated requirement and will continue to do so. A 2005 OIG report OEI020300530 found that OPA has informed and periodically reminded Title X grantees of their responsibilities regarding state child-abuse and sexualabuse reporting requirements.
Given the comments received and that Title X compliance with state mandatory reporting is already required through a legislative mandate for the Title X program, the Department does not deem it necessary to include this provision within the final regulation itself. Furthermore, this provision was a part of the 2019 rule that is being rescinded as a whole because it was a set of interrelated requirements that did not promote the public health or solve any Title X compliance concerns. In conclusion, the Department removes language from the NPRM for 59.5a12 from the 2021 final rule.
59.5a13. Subrecipient Monitoring In the NPRM, the Department proposed adding 59.5a13 to retain some, but not all, of the language from the 2019 rule related to subrecipient monitoring and reporting. This addition required Title X grantees to report on the subrecipients and referral agencies involved in their Title X projects and to provide their plan for oversight and monitoring of their subrecipients in grantee reports.
The NPRM language stated, Ensure transparency in the delivery of services by reporting the following information in grant applications and all required reports: i Subrecipients and agencies or individuals providing referral services and the services to be provided;
ii Description of the extent of the collaboration with subrecipients, referral agencies, and any individuals providing referral services, in order to demonstrate a seamless continuum of care for clients; and iii Explanation of how the recipient will ensure adequate oversight and accountability for quality and effectiveness of outcomes among subrecipients.
Comments: The Department received several comments expressing concerns with the requirements of this provision and the high reporting burden associated with it. One comment requested that section 59.5a13 be
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