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HHS Revises Rules for Title X Family Planning Services

April 16, 2021

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CONTACTS
Phoebe Ramsey, Sr. Regulatory Analyst, Quality & Payment Policy

On April 15, the Department of Health and Human Services (HHS) published a proposed rule, “Ensuring Access to Equitable, Affordable, Client-Centered, Quality Family Planning Services,” to formally repeal the 2019 rules for Title X grants that limited access to family planning services for many low-income people. Comments are due on May 17.

Specifically, the proposal would return to regulations promulgated in 2000, with modifications to strengthen the program, which provides comprehensive family planning services and other basic health care. The AAMC previously submitted comments on the proposed changes that were finalized in 2019, in which it urged the department to withdraw the proposals out of concern that the policies would undermine standards of medical professionalism, harm patients who rely on Title X providers as an essential source of their health care, and add burdensome requirements without commensurate benefit [refer to Washington Highlights, Aug. 3, 2018].

The HHS cites the detrimental public health impact resulting from the 2019 rules as the reason to return to the prior regulations. The department found that the program lost more than 1,000 service sites overall in response to the changes, and that Title X services are not currently available in six states due to having no provider sites. Furthermore, the department has observed a “dramatic” decrease in family planning and related preventive health services provided under the program. In the proposed rule, the HHS states that “[u]ltimately, continued enforcement of the 2019 rule raises the possibility of a two-tiered healthcare system in which those with insurance and full access to healthcare receive full medical information and referrals, while low-income populations with fewer opportunities for care are relegated to inferior access.”

The proposed rule would:

  • Remove the 2019 rule requirements for physical and financial separation of abortion services.
  • Reinstate the requirement that methods of family planning be “medically approved.”
  • Allow Title X-supported providers to offer patients the full range of information about their health care options and refer patients to providers who offer their preferred family planning methods, including abortion services.
  • Define program regulations — including “adolescent-friendly health services,” “client-centered care,” “health equity,” “inclusivity,” “quality healthcare,” and “trauma-informed” — based on use of these terms by government agencies or major medical associations to ensure equitable care under the program.
  • Broaden the scope of health care providers of consultative services beyond physicians to include physician assistants and nurse practitioners.
  • Incorporate more inclusive language in regulation by replacing the term “handicapped condition” with “disability,” the term “women” with “client,” and the term “persons” with “clients.”
  • Retain the long-standing prohibition on directly promoting or performing abortion, as required under statute.

The proposed rule also refers to allowing family planning services to be provided using telemedicine, though it does not provide additional detail.

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