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Federal Register / Vol. 86, No. 192 / Thursday, October 7, 2021 / Rules and Regulations fewer clients received intrauterine devices IUDs. For oral contraceptives and IUDs, this was a 27 percent reduction, and for hormonal implants, a 21 percent reduction. These percentages are similar in magnitude to the 21
percent reduction in clients served in 2019 compared to 2018. Additionally, 90,386 and 188,920 fewer Pap tests and clinical breast exams, respectively, were performed in 2019 compared to 2018.
Confidential HIV tests decreased by 276,109. Testing for STIs decreased by 256,523 for chlamydia, 625,802 for gonorrhea, and 77,524 for syphilis.
Appendix A of the FPAR contains national annual trends for many of the services discussed above. The reductions in services reported in 2019
compared to 2018 represent the largest year-over-year reductions in services for each reported measure since at least 2014. Similar to the earlier discussion relating to long-term trends relating to clients, we attribute the bulk of the reductions to these services to the 2019
final rule.
For the forecast of services provided under the baseline scenario, the Department adopts the percentage of TABLE D2BASELINE FORECAST OF
clients receiving each service in the TITLE X SERVICES
2019 Title X Family Planning Annual Baseline forecast Annual Report. For example, in 2019, about 23
percent of female clients received a Grantees
75
clinical breast exam. The Department Subrecipients
867
Service Sites
3,031 assumes the same share of clients will Clients Served
2,512,066 be served by Title X for screening and STI testing. Table D3 reports the best In addition to the reduction in estimate of the annual services provided grantees, subrecipients, service sites, under the baseline scenario. These and total client served, the Department services are described in greater detail notes that six states currently have no later in this Section.
Title X services, including HI, ME, OR, UT, VT, and WA. There are six TABLE D3BASELINE TITLE X CANadditional states that have limited Title CER SCREENING AND SEXUALLY
X services, including AK, CT, MA, MN, TRANSMITTED INFECTION TESTING
NH, and NY.15
In line with the reduction in clients Year Annual served under the 2019 rule, data also reveal a significant drop in services Clinical Breast Exams
509,550
provided. For example, when Pap Tests
443,087
comparing 2019 figures to 2018, 225,688 Chlamydia Test 1,266,508
fewer clients received oral Gonorrhea Test
1,420,198
contraceptives; 49,803 fewer clients Syphilis Test
536,619
received hormonal implants; and 86,008
program under the current regulations since services were likely disrupted by the ongoing public health emergency.
As the primary estimate, the Department adopts 2,512,066 clients served as the baseline annual impact of Title X under the policies of the 2019
rule. This 2.5 million-figure corresponds to the number of clients served in 2019
among remaining grantees as of March 2021. For comparison, this primary estimate represents a 37 percent reduction in clients served compared to the average of clients served from 2016
to 2018. In the Uncertainty and Sensitivity Analysis Section, the Department adopts the 1.5 millionclient figure as a lower-bound estimate, and 3.1 million clients as an upperbound estimate of the annual program impact under the baseline.
Table D2 summarizes the baseline forecast for the same categories of historical data presented in Table D1.
The Department adopts the current count for grantees, subrecipients, and services sites and assumes constant funding and that these figures will be constant over the time horizon of this analysis.

56171

TABLE D3BASELINE TITLE X CANCER SCREENING AND SEXUALLY
TRANSMITTED INFECTION TESTING
Continued Year
Annual
Confidential HIV Test

777,536

Source: Calculations based on Title X Family Planning Annual Report, 2019: Exhibits 26
and 29.

The Department predicts that the main effect of the final rule would be to return to Title X program impact levels observed prior to the 2019 rule. The estimates of the long-run equilibrium of grantees, subrecipients, service sites, and total clients served are informed by the data from 2016 to 2018, the last three years of data that are unaffected by the declines experienced following the 2019 rule. Specifically, the Department adopts the average across these three years as the long-run estimates. These averages are 93 grantees, 1,112
subrecipients, 3,903 service sites, and approximately 4.0 million clients served.
To complete the forecast of the policy scenario, the Department assumes that it will take two years for program participation and clients served to achieve the long-run equilibrium estimates. This two-year phase-in is consistent with a scenario in which most service sites that withdrew from the Title X program have remained open, with some operating at a lower capacity, than they did prior to the 2019
rule. It is also consistent with an expectation that many of the grantees and service sites that withdrew from the program would be able to rejoin if the NPRM issued on April 15, 2021, were finalized. In year one, following the effective date of the proposed rule, the number of clients served would increase to approximately 3.2 million. In year two, this number would increase again to approximately 4.0 million and remain constant for the duration of the analysis.
These figures are presented in Table D4.
The Department acknowledges uncertainty in this estimate and includes a discussion in the Uncertainty and Sensitivity Section, below.

TABLE D4POLICY SCENARIO FORECAST OF TITLE X SERVICE GRANTEES

lotter on DSK11XQN23PROD with RULES3

Year Grantees
Subrecipients
Service Sites
Clients Served
15 As noted earlier, seven states CO, DE, KY, ND, NM, NV, TX experienced a meaningful increase in
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2022

2023

2024

2025

2026

84
990
3,467
3,247,958

93
1,112
3,903
3,983,849

93
1,112
3,903
3,983,849

93
1,112
3,903
3,983,849

93
1,112
3,903
3,983,849

the number of Title X clinics after the 2019
regulatory change.

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