On Oct. 7, the Department of Health and Human Services (HHS) issued a final rule to update program regulations for Title X family planning services, based upon proposals issued earlier this year. The AAMC submitted comments in support of the revisions to the program [refer to Washington Highlights, May 21]. The rule is effective Nov. 8.
The rule returns the program to regulations promulgated in 2000, reversing policy changes finalized in a 2019 rule that the HHS has since found to have had a detrimental public health impact. Specifically, the new regulations removed 2019 rule requirements for physical and financial separation of abortion services and reinstated the requirement that methods of family planning be “medically approved.” This regulation also removed 2019 rule limits on the information about health care options and referrals that Title X-supported providers may offer. The program will again allow providers to refer patients to other providers who offer the patient’s preferred family planning method, including abortion services. The HHS noted that the rule retains the long-standing prohibition on directly promoting or performing abortions, as required under statute.
In addition, the department made modifications to the program’s policies in an effort to strengthen the program and increase access to affordable, quality family planning services. These policy changes included the adoption of newly defined terms in program regulations — including “adolescent-friendly health services,” “client-centered care,” “health equity,” “inclusivity,” “quality healthcare,” and “trauma-informed” — based on the use of these terms by government agencies or major medical associations to ensure equitable care under the program. The regulation also incorporated more inclusive language in the program by replacing the term “handicapped condition” with “disability,” the term “women” with “client,” and the term “persons” with “clients.” Finally, the HHS updated the definition of “sex” to include the newly defined terms “sexual orientation,” “gender identity,” and “sex characteristics” as part of the broader requirement that Title X grantees “provide services in a manner that does not discriminate against any patient based on religion, race, color, national origin, disability, age, sex, number of pregnancies, or marital status.”
The HHS also broadened the scope of health care providers of consultative services beyond physicians to include physician assistants and nurse practitioners. The department also specifically clarified in regulatory text that telehealth services constitute appropriate service delivery under the Title X program. The HHS intends to provide additional training and technical assistance to Title X-supported providers on the use of various telehealth modalities to improve access, quality, and equity.