Voglio sapere a riguardo di…

56164

Federal Register / Vol. 86, No. 192 / Thursday, October 7, 2021 / Rules and Regulations
lotter on DSK11XQN23PROD with RULES3

Title X services. The Department also agrees with comments that other healthcare providers, including physician assistants and APRNs in many states, have authority to direct family planning programs and should be included within the regulation.
As stated earlier, the Department received comments in response to 59.5b1 asking for more clarity on the term healthcare providers included in the NPRM, with many comments recommending use of the term clinical services provider as defined by OPA in FPAR. As a result, the Department has revised the final language for 59.5b1
to use the term clinical services provider instead of healthcare provider and has revised 59.2 to include the FPAR definition of clinical services provider in the regulatory text.
The FPAR definition for clinical services provider includes physicians, physician assistants, nurse practitioners, certified nurse midwives, and registered nurses with an expanded scope of practice who are trained and permitted by state-specific regulations to perform all aspects of the user male and female physical assessments recommended for contraceptive, related preventive health, and basic infertility care.
To ensure consistency between 59.5b1 and 59.5b6 as requested in the public comments, the Department has revised the language for the 2021
rule for 59.5b6 to, Provide that family planning medical services will be performed under the direction of a clinical services provider, with services offered within their scope of practice and allowable under state law, and with special training or experience in family planning. This revised language for 59.5b6 is adopted as final.
59.5b8 Coordination and Use of Referrals and Linkages In the NPRM, the Department proposed revising section 59.5b8 of the 2000 regulations to add language to include primary healthcare providers in the list of referrals and to state that referrals are to be to providers in close proximity to the Title X site when feasible. The NPRM stated, Provide for coordination and use of referrals and linkages with primary healthcare providers, other providers of healthcare services, local health and welfare departments, hospitals, voluntary agencies, and health services projects supported by other federal programs 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.
Comments: The Department received several comments expressing support
VerDate Sep<11>2014

22:06 Oct 06, 2021

Jkt 256001

for revising the provision to include primary healthcare providers in the list of referrals and to require that referrals be to nearby providers, when feasible.
One comment expressed support and said that referring Title X patients to local primary care physicians would facilitate access to continuous, comprehensive healthcare. Several other comments expressed support and stressed the existing collaborative relationships between many HRSAfunded health centers and Title X sites.
Comments expressed that referral relationships allow the health center and the Title X site to become more familiar with one anothers operations and service lines, often serving as a useful precursor to a more integral relationship in the future.
Response: The Department appreciates the many supportive comments in response to this revised provision. The Department agrees that it is important for Title X clinics to provide referrals and linkages to a wide range of healthcare services to help facilitate access for Title X clients to needed healthcare services beyond family planning. Given that the Department received no comments expressing concern with or opposition to the proposed modification, the Department adopts the language from the NPRM for 59.5b8 as final without revisions.
59.6 Suitability of Informational and Educational Material In the NPRM, the Department proposed revising the 2000 regulations by combining requirements specific to the Information and Education Advisory Committee Advisory Committee that were in sections 59.5a11 and 59.6
and consolidating all of the Advisory Committee information in one place, under section 59.6. The NPRM proposed several revisions to 59.6 to clarify that the regulation applies to both print and electronic materials in both the title of the section and regulatory text, that the upper limit on council members should be determined by the grantee, that the factors to be considered for broad representation on the Advisory Committee match the definition of inclusivity earlier in the regulation, and that materials will be reviewed for medical accuracy, cultural and linguistic appropriateness, and inclusivity and to ensure they are trauma-informed.
Specifically, the NPRM states:
a A grant under this section may be made only upon assurance satisfactory to the Secretary that the project shall provide for the review and approval of informational and educational materials
PO 00000

Frm 00022

Fmt 4701

Sfmt 4700

print and electronic developed or made available under the project by an Advisory Committee prior to their distribution, to assure that the materials are suitable for the population or community to which they are to be made available and the purposes of Title X of the Act. The project shall not disseminate any such materials which are not approved by the Advisory Committee.
b The Advisory Committee referred to in paragraph a of this section shall be established as follows:
1 Size. The Committee shall consist of no fewer than five members and up to as many members as the recipient determines, except that this provision may be waived by the Secretary for good cause shown.
2 Composition. The Committee shall include individuals broadly representative of the population or community for which the materials are intended in terms of demographic factors such as race, ethnicity, color, national origin, disability, sex, sexual orientation, gender identity, age, marital status, income, geography, and including but not limited to individuals who belong to underserved communities, such as Black, Latino, and Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color;
members of religious minorities;
lesbian, gay, bisexual, transgender, and queer LGBTQ+ persons; persons with disabilities; persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or inequality.
3 Function. In reviewing materials, the Advisory Committee shall:
i Consider the educational, cultural, and diverse backgrounds of individuals to whom the materials are addressed;
ii Consider the standards of the population or community to be served with respect to such materials;
ii Review the content of the material to assure that the information is factually correct, medically accurate, culturally and linguistically appropriate, inclusive, and traumainformed;
iii Determine whether the material is suitable for the population or community to which is to be made available; and iv Establish a written record of its determinations.
Comments: The Department received one comment in support of the proposed revisions that expressed that this will ensure that information and materials provided to clients are appropriate and suitable for the specific communities to be served. Another
E:FRFM07OCR3.SGM

07OCR3