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This action would finalize revisions to the Title X regulations to ensure compliance with, and enhance the implementation of, various statutory program integrity requirements, including the statutory requirement that none of the funds appropriated for Title X may be used in programs where abortion is a method of family planning.

Statement of Need:

This action should enhance compliance with the statutory program integrity requirements applicable to, and purpose and goals of, the Title X program (especially those related to section 1008), the appropriations provisos and riders addressing the Title X program, and other obligations and requirements established under other Federal law.  The action should also enhance programmatic transparency regarding the provision of Title X services (with respect to both the identity of the providers and the services being provided by such entities).

Summary of the Legal Basis:

The Department has legal authority to issue and amend regulations to implement Title X of the Public Health Service (PHS) Act (42 U.S.C. 300 300a-6), in order to establish the requirements applicable to projects for family planning services, pursuant to section 1006 of the Public Health Service Act, 42 U.S.C. 300a-4; section 1006 also provides priority for low-income families.  Section 1001 of the PHS Act establishes certain parameters for voluntary Title X family planning projects/programs, including the offering of a broad range of acceptable and effective family planning methods and services (including natural family planning methods, infertility services, and services for adolescents) and the encouragement, to the extent practical, of family participation.  Section 1008 of the PHS Act, 42 U.S.C. 300a-6, establishes the prohibition on the use of the funds appropriated for Title X "in programs where abortion is a method of family planning."

In addition, the annual Labor-HHS appropriations act imposes, on an annual basis, certain additional requirements with respect to the Title X program, including that all pregnancy counseling be nondirective; that Title X funds not be expended for any activity that in any way tends to promote public support or opposition to any legislative proposal or candidate for public office; that Title X grant applicants certify to the Secretary that they encourage family participation in the decision of minors to seek family planning services and provide counseling to minors on how to resist attempts to coerce them into engaging in sexual activities; and that Title X providers  comply with State laws requiring notification or the reporting of child abuse, child molestation, sexual abuse, rape, or incest.  See, e.g., Consolidated Appropriations Act, 2018, Pub. L. 115-141, Div. H, 207-208, Title II, 132 Stat. 348, 716-17.  

Finally, the action would ensure that the Title X program and Title X providers comply with laws that protect the conscience rights of individuals and entities who decline to perform, participate in, or refer for abortions, including the Church Amendments (42 U.S.C. 300a-7), the Coats-Snowe Amendment (42 U.S.C. 238n), and the Weldon Amendment, see, e.g., Consolidated Appropriations Act, 2018, Public Law 115-141, Div. H, 507(d), 132 Stat. 348, 764 (2018).

The Department has legal authority to issue and amend regulations to implement Title X of the Public Health Service (PHS) Act (42 U.S.C. 300 300a-6), in order to establish the requirements applicable to projects for family planning services, pursuant to section 1006 of the Public Health Service Act, 42 U.S.C. 300a-4; section 1006 also provides priority for low-income families.  Section 1001 of the PHS Act establishes certain parameters for voluntary Title X family planning projects/programs, including the offering of a broad range of acceptable and effective family planning methods and services (including natural family planning methods, infertility services, and services for adolescents) and the encouragement, to the extent practical, of family participation.  Section 1008 of the PHS Act, 42 U.S.C. 300a-6, establishes the prohibition on the use of the funds appropriated for Title X "in programs where abortion is a method of family planning."

In addition, the annual Labor-HHS appropriations act imposes, on an annual basis, certain additional requirements with respect to the Title X program, including that all pregnancy counseling be nondirective; that Title X funds not be expended for any activity that in any way tends to promote public support or opposition to any legislative proposal or candidate for public office; that Title X grant applicants certify to the Secretary that they encourage family participation in the decision of minors to seek family planning services and provide counseling to minors on how to resist attempts to coerce them into engaging in sexual activities; and that Title X providers  comply with State laws requiring notification or the reporting of child abuse, child molestation, sexual abuse, rape, or incest.  See, e.g., Consolidated Appropriations Act, 2018, Pub. L. 115-141, Div. H, 207-208, Title II, 132 Stat. 348, 716-17.  

Finally, the action would ensure that the Title X program and Title X providers comply with laws that protect the conscience rights of individuals and entities who decline to perform, participate in, or refer for abortions, including the Church Amendments (42 U.S.C. 300a-7), the Coats-Snowe Amendment (42 U.S.C. 238n), and the Weldon Amendment, see, e.g., Consolidated Appropriations Act, 2018, Public Law 115-141, Div. H, 507(d), 132 Stat. 348, 764 (2018).

Alternatives:

The Department continues to consider alternative approaches that would ensure (1) sufficient compliance with the statutory program integrity requirements and purpose and goals of the Title X program, the appropriations provisos and riders addressing the Title X program, and other obligations and requirements established under other Federal law, and (2) transparency regarding the provision of services (with respect to both the identity of the providers and the services being provided by such entities).

Anticipated Costs and Benefits:

The changes proposed will improve the integrity of Title X program, especially with respect to ensuring that projects and providers do not fund, support, or promote abortion as a method of family planning, and enhance compliance with statutory requirements and appropriations riders and provisos.  In addition, it is expected that the changes will facilitate the ability of an expanded number of entities to participate in Title X, including by removal of abortion counseling and referral requirements that potentially violate Federal health care conscience protections; this should serve to expand and enhance patient service and care.  The proposed rule estimated $13.6 million in annualized costs at a 7% discount rate.

Risks:

None known.