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Federal Register / Vol. 86, No. 192 / Thursday, October 7, 2021 / Rules and Regulations
Grantees, 867 Subrecipients, 3,031
Service Sites, and 1,536,743 Clients Served, compared to 73 Grantees, 803
Subrecipients, 2,682 Service Sites, and 1,536,744 Clients Served reported in the PRIA. These revised estimates carry through to other estimates and Tables.
As described in greater detail in the Preamble, the final rule adopts eight of the fourteen revisions initially proposed in the NPRM and nine of the ten technical corrections initially proposed in the NPRM as final without additional changes. 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 compared to what was proposed in the NPRM. This analysis has been updated to be consistent with these changes, but these changes do not substantially alter the estimates of the quantified economic impacts.
E. Final Economic Analysis of Impacts a. Background The Title X family planning program, administered by the U.S. Department of Health and Human Services HHS, Office of Population Affairs OPA, is the only federal program dedicated solely to supporting the delivery of family planning and related preventive healthcare. The program is designed to provide a broad range of acceptable and effective family planning methods and services including natural family planning methods, infertility services, and services for adolescents with priority given to persons from lowincome families. In addition to offering these methods and services on a voluntary and confidential basis, Title X-funded service sites provide
contraceptive education and counseling;
breast and cervical cancer screening;
STIs and HIV testing, referral, and prevention education; and pregnancy diagnosis and counseling. The program is implemented through competitively awarded grants to state and local public health departments and family planning, community health, and other private nonprofit agencies. In fiscal year 2021, the Title X program received approximately $286.5 million in discretionary funding.14
On March 4, 2019, HHS published a final rule to prohibit family planning projects from using Title X funds to encourage, promote, provide, refer for, or advocate for abortion as a method of family planning; require assurances of compliance; eliminate the requirement that Title X projects provide abortion counseling and referral; require physical and financial separation of Title X
activities from those which are prohibited under section 1008; provide clarification on the appropriate use of funds in regard to the building of infrastructure, and require additional reporting burden from grantees.
b. Market Failure or Social Purpose Requiring Federal Regulatory Action The regulatory impact analysis associated with the 2019 rule predicted that the additional restrictions on grantees would result in an expanded number of entities interested in participating in Title X. Further, the analysis suggested the 2019 rule would result in enhanced patient service and care. Contrary to these predictions, during the initial period of the 2019
rules implementation, the policy appears to have had the opposite effect.
As described in greater detail in the Baseline section, the restrictions
included in the 2019 rule are associated with a substantial reduction in the number of Title X grantees, subrecipients, and service sites, resulting in a corresponding reduction in total clients served. The Department is compelled to act quickly to ameliorate these negative consequences by promulgating this final rule since the Title X program serves a low-income population that is particularly vulnerable to losing access to these services. This final rule is needed to improve the functioning of government and the effectiveness of the Title X
program.
c. Purpose of the Rule This final rule will revise the regulations that govern the Title X
family planning services program by revoking the 2019 rule and readopting the 2000 regulations with several modifications. This approach will allow the Title X program grantees, subrecipients, and service sites to have a greater impact on public health than under the current regulatory approach.
d. Baseline Conditions and Impacts Attributable to the Rule The Department adopts a baseline that assumes the requirements of the 2019
rule remain in place over the period of our analysis. To characterize the realworld impact of the Title X program under this regulatory approach, the Department developed an annual forecast of grantees, subrecipients, service sites, and total clients served.
The key inputs to the forecast are historical data on Title X service grantees. For calendar years 2016 to 2020, this information is summarized in the 2020 Title X Family Planning Annual Report.

TABLE D1TITLE X SERVICE GRANTEES
Year Grantees
Subrecipients
Service Sites
Clients Served

2016

2017

2018

2019

2020

91
1,117
3,898
4,007,552

89
1,091
3,858
4,004,246

99
1,128
3,954
3,939,749

100
1,060
3,825
3,095,666

75
867
3,031
1,536,743

lotter on DSK11XQN23PROD with RULES3

Source: Title X Family Planning Annual Report, 2020: Exhibit A2a.

The data for calendar years 2016
2019 included all grantees, subrecipients, and service sites operating at any time during the year.
The implementation of the 2019 rule occurred mid-year in 2019. Following this regulation, 19 grantees, 231
subrecipients, and 945 service sites withdrew from the Title X program. The 14 Does
reduced number of grantees, subrecipients, services sites, and clients served observed in 2019 and 2020
cannot be explained by a reduction in discretionary funding for the program, which has remained constant at $286.5
million throughout this time period.
Since the 2019 figure includes clients served by these service sites for more
than half of the year, adopting 3.1
million clients served as an annual forecast would likely overstate activity in the program under the current regulations. Indeed, preliminary figures for 2020 approximate that only 1.5
million clients were served. However, this figure likely represents an underestimate for a typical year of the
not include supplemental funding.

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