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Federal Register / Vol. 86, No. 192 / Thursday, October 7, 2021 / Rules and Regulations comment shared specific support for the requirement that grantees provide culturally and linguistically appropriate materials. One comment opposed to this provision expressed that the language in 59.6 remains overly narrow and prescriptive and recommended that the language be revised to require a Community Advisory Board charged with a broad array of responsibilities to ensure the appropriateness of Title X services for intended communities. Another comment opposed underrepresented communities in composition of the advisory council and claimed that to the extent it results in segregation or prioritization of Title X services or committee membership by protected classes such as race, it violates the Constitution and several civil rights laws. This same comment also opposed having the advisory committee review materials to certify that they are trauma-informed and inclusive.
Response: The Department appreciates the supportive comment in response to this provision. The role of the Advisory Committee is critically important to ensure that the information and educational materials provided to Title X clients are factually correct, medically accurate, culturally and linguistically appropriate, inclusive, and trauma-informed. Engaging the community and population served in the Advisory Committee itself is a key strategy to inform the grantee about the needs and experiences of the community and population served, and to make sure that the information and education materials are appropriate for the community and population served.
The Department disagrees with the comment that the language in 59.6 is too narrow and prescriptive. The Department believes that the requirements set forth in 59.6 are critical for ensuring that informational and educational materials provided to Title X clients are factually correct, medically accurate, culturally and linguistically appropriate, inclusive, and trauma-informed. In addition, the Title X statute prescribes requirements related to the informational and educational materials developed or made available under the project, including that they will be suitable for the purposes of Title X and for the population or community to which they are to be made available, taking into account educational and cultural background of the individuals to whom such materials are addressed and the standards of such population or community with respect to such materials PHS Act sec. 1006d1, and also prescribes requirements related
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to the Advisory Committee, including that the committee shall include individuals broadly representative of the population or community to which the materials are to be made available PHS Act sec. 1006d2.
The Department also disagrees with the comment that the regulation is segregating or prioritizing services or committee members. The text of the provision calls for the Committee membership to include individuals broadly representative of the population or community for which the materials are intended. . . . Including but not limited to individuals who belong to underserved communities. Since all communities served are different, the aim of this provision is to ensure the committee is representative of the community and population served, as required by the statute. The Department disagrees with the opposition to having the Advisory Committee review materials to ensure they are inclusive and trauma-informed. Providing information and educational materials that are inclusive and trauma-informed are a critical component of providing quality, client-centered care.
The Department does not believe that revisions are needed to the regulatory text included in the NPRM. As a result, the Department adopts the language from the NPRM for 59.6 as final with a technical correction to include sex characteristics.
59.7 Grant Review Criteria In the NPRM, the Department proposed revising section 59.7 of the 2000 regulations to add one additional review criterion that the Department may consider in deciding which family planning projects to fund and in what amount, which is the ability of the applicant to advance health equity.
Adding this new criterion to the 2000
regulations brings the total number of grant review criteria specified in the regulation from seven to eight.
Advancing health equity is critical to the mission of the Title X program. The addition of this grant review criterion will help ensure that grant funds are awarded to those applicants who are best able to help the Department in achieving the goal of advancing health equity through the Title X program.
Comments: The Department received several comments in response to this revised provision asking for additional details in future funding opportunities about what the new criterion means and how it will be measured. One comment provided specific examples of how the Department could operationalize the new grant review criterion. Another comment asked the Department to
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develop additional guidance and tools that Title X sites and other healthcare organizations can readily implement to meaningfully advance health equity.
Still another comment expressed concern that the NPRM did not include an explanation for how a Title X
project can, in fact, ensure equity in general and specifically in a way that does not lead to actual discrimination based on a protected basis.
Response: The Department appreciates the comments and recommendations received. The grant review criteria from the 2000 regulation include several criteria aimed at assessing the need, capacity, and ability of the applicant organization, including the relative need of the applicant, the capacity of the applicant to make rapid and effective use of the federal assistance, the adequacy of the applicants facilities and staff, the relative availability of non-federal resources within the community to be served and the degree to which those resources are committed to the project, and the degree to which the project plan adequately provides for the requirements set forth in these regulations. In addition, the grant review criteria from the 2000 regulation include two criteria aimed at assessing need in the communities served, including the number of clients, and, in particular, the number of low-income clients to be served; and the extent to which family planning services are needed locally.
The Department believes that adding the new grant review criterion to assess the ability of the applicant to advance health equity is important to enable OPA to more fully assess the extent to which the applicants project will promote health equity through the Title X services provided. Under 59.2, health equity is defined as when every person has the opportunity to attain their full health potential and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances.
Adding a focus on advancing health equity will not lead to discrimination or preferential treatment as expressed by some comments opposed to the NPRM.
Rather, including a focus on advancing health equity aims to ensure that all people can actively participate in and benefit from family planning services.
By advancing equity across the federal government, we can create opportunities for the improvement of communities that have been historically underserved, which benefits everyone.
The federal governments goal in advancing equity is to provide everyone
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