7714 Federal Register / Vol. 84, No. 42 / Monday, March 4, 2019 / Rules and Regulations DEPARTMENT OF HEALTH AND (8), 59.13, 59.14, 59.17, and 59.18 is 3. Removal of the Requirement for HUMAN SERVICES required by July 2, 2019. Consultation (42 CFR 59.5(a)(10)) Compliance for all other requirements 4. Promotion of Access to Comprehensive 42 CFR Part 59 of this final rule is required by the Primary Health Services (42 CFR effective date, that is, by May 3, 2019. 59.5(a)(12)) [HHS–OS–2018–0008] 5. Title X Transparency (42 CFR 59.5(a)(13) FOR FURTHER INFORMATION CONTACT: The RIN 0937–ZA00 6. Encouragement of Family Participation Office of the Assistant Secretary for (42 CFR 59.5(a)(14)) Health (OASH) at (202) 690–7694, Compliance With Statutory Program 7. Provide for Medically Necessary [email protected], or by mail at 200 Integrity Requirements Services (42 CFR 59.5(b)(1)) Independence Avenue SW, Washington, 8. Provide for Coordination and Referral, AGENCY: Office of the Assistant DC 20201 Consistent With Prohibition on Referral Secretary for Health, Office of the SUPPLEMENTARY INFORMATION: for Abortion (42 CFR 59.5(b)(1)) Secretary, HHS. Department of Health F. Criteria for Selection of Grantees (42 Table of Contents CFR 59.7) and Human Services. G. Confidentiality (42 CFR 59.11) ACTION: Final rule. I. Executive Summary and Background H. Standards of Compliance With A. Executive Summary Prohibition on Abortion (42 CFR 59.13) SUMMARY: The Office of Population 1. Purpose I. Requirements and Limitations With Affairs (OPA), in the Office of the 2. Summary of the Major Provisions Respect to Post-Conception Activities (42 Assistant Secretary for Health, issues a. Clear Financial and Physical Separation CFR 59.14) b. Ensure Transparency for Legal and this final rule to revise the regulations 1. Prohibition on Referral For, and Ethical Use of Taxpayer Dollars Among Encouragement, Promotion, Advocacy, that govern the Title X family planning Subrecipients Support, and Assistance of, Abortion as program (authorized by Title X of the c. Nondirective Pregnancy Counseling a Method of Family Planning (42 CFR Public Health Service Act) to ensure Permitted, Not Required 59.14(a), 59.5(a)(5), and 59.16(a)) compliance with, and enhance d. Referral for Abortion as a Method of 2. Information About Prenatal Care, Use of Family Planning Prohibited, No Longer implementation of, the statutory Permitted Information To Refer for Required requirement that none of the funds Abortion, and Examples (42 CFR e. Sexual Abuse Reporting Requirements appropriated for Title X may be used in 59.14(b)(1), (c), and (e)) Training and Protocols programs where abortion is a method of 3. Emergency Care and Medically f. Family Participation in Family Planning family planning and related statutory Necessary Information (42 CFR Decisionmaking requirements. Accordingly, OPA g. Expanded Review and Selection Criteria 59.14(b)(2) and 59.14(d)) amends the Title X regulations to clarify h. Formal Revocation of Compliance With J. Maintenance of Physical and Financial grantee responsibilities under Title X, to Title X Requirements by Project Separation (42 CFR 59.15) remove the requirement for nondirective Recipients in Selecting Subrecipients K. Prohibition on Activities That abortion counseling and referral, to Rule Encourage, Promote or Advocate for 3. Summary of Costs, Savings and Benefits Abortion (42 CFR 59.16) prohibit referral for abortion, and to L. Compliance With Reporting clarify compliance obligations with state of the Major Provisions B. Background Requirements (42 CFR 59.17) and local laws. In addition, Title X M. Appropriate Use of Funds (42 CFR regulations are amended to clarify II. Statutory Authority, Overview, Analysis, and Response to Public Comments 59.18) access to family planning services A. General Comments N. Transition Provisions (42 CFR 59.19) where an employer exercises a religious B. To what programs do these regulations III. Economic/Regulatory Impact and or moral objection. Finally, Title X apply? (42 CFR 59.1) Paperwork Burden regulations are amended to require C. Definitions (42 CFR 59.2) A. Introduction and Summary physical and financial separation to 1. Definition of Advanced Practice 1. Executive Orders 12866 and 13563 and ensure clarity regarding the purpose of Provider the Congressional Review Act 2. Regulatory Flexibility Act (RFA) Title X and compliance with statutory 2. Definition of Family Planning 3. Definition of Grantee 3. Unfunded Mandates Reform Act program integrity provisions, and to 4. Federalism encourage family participation in family 4. Definition of Low Income Family 5. Definition of Program or Project 5. Summary of the Final Rule planning decisions, as required by 6. Definition of Subrecipient B. Analysis of Economic Impacts Federal law. D. Who is eligible to apply for a family 1. Need for Regulatory Action DATES: Effective date: This rule is planning services grant or contract? (42 2. Affected Entities effective on May 3, 2019. CFR 59.3) 3. Estimated Costs Compliance date: Compliance with E. What requirements must be met by a a. Learning the Rule’s Requirements b. Training the physical separation requirements family planning project? (42 CFR 59.5) c. Assurance Submissions contained in § 59.15, is required March 1. Broad Range of Acceptable and Effective Family Planning Methods (42 CFR d. Documentation of Compliance 4, 2020. 59.5(a)(1)) e. Monitoring and Enforcement Compliance with the financial a. Acceptable and Effective Methods and f. Physical Separation separation requirements contained in Services g. Encouraging Parental Involvement in § 59.15 is required by July 2, 2019. Until b. Projects Required To Provide a Broad Family Planning Services that date, the Department will expect Range of Family Planning Methods and 4. Estimated Benefits grantees to comply with either § 59.15 Services, But Participating Entities May a. Upholding and Preserving the Purpose or the ‘‘Separation’’ section of the Offer a Limited Number of Family and Goals of the Title X Program guidance at 65 FR 41281, 41282. Planning Methods and Services b. Patient/Provider Benefits and Compliance with §§ 59.7 and c. Listing Particular Services in the Broad Protections Range of Family Planning Services That C. Analysis of Regulatory Alternatives 59.5(a)(13) is required by July 2, 2019. May Be Provided D. Executive Order 13771 Compliance for reporting, assurance, 2. Projects Shall Not Provide, Promote, E. Regulatory Flexibility Analysis and provision of service in Refer For, or Support Abortion as a F. Assessment of Federal Regulation and §§ 59.5(a)(12) and (13) as it applies to all Method of Family Planning (42 CFR Policies on Families required reports, 59.5(a)(14), (b)(1) and 59.5(a)(5)) G. Paperwork Reduction Act VerDate Sep<11>2014 19:45 Mar 01, 2019 Jkt 247001 PO 00000 Frm 00002 Fmt 4701 Sfmt 4700 E:\FR\FM\04MRR3.SGM 04MRR3 Federal Register / Vol. 84, No. 42 / Monday, March 4, 2019 / Rules and Regulations 7715 I. Executive Summary and Background 2. Summary of the Major Provisions to prevent the dilution of Title X resources. A. Executive Summary a. Clear Financial and Physical Separation b. Ensure Transparency for Legal and 1. Purpose This rule finalizes requirements that Ethical Use of Taxpayer Dollars Among The primary purpose of this rule is to ensure clear physical and financial Subrecipients separation between a Title X program finalize, with changes in response to This rule facilitates the legal and and any activities that fall outside the public comments, revisions to the Title ethical use of taxpayer dollars by program’s scope. This physical and X family planning regulations proposed implementing reporting requirements 1 financial separation will ensure on June 1, 2018. This rule, promulgated with respect to the use of Title X funds. pursuant to the Department’s authority,2 compliance with the statutory requirement that Title X funding not The 2000 regulations do not require will ensure compliance with, and grantees to submit significant enhance implementation of, the support programs where abortion is a method of family planning—and is information to the government about statutory requirement that none of the their subrecipients, referral agencies, or funds appropriated for Title X may be consistent with the plain text of Section 1008, legislative history, and case law. other partners to whom Title X funds used in programs where abortion is a may flow. This lack of reporting can be method of family planning, as well as In particular, the rule protects against the intentional or unintentional co- a significant barrier to the Department’s related statutory requirements. In ability to ensure Title X funds are addition, the rule ensures that grantee mingling of Title X resources with non- Title X resources or programs by directed only to Title X activities. responsibilities, referral requirements, amending the Department’s regulation Accordingly, the final rule requires that and documentation obligations are clear finalized on July 3, 2000, (the ‘‘2000 Title X grant applicants include, as part under the Title X program. The rule also regulations’’), which required no of their applications, a list of all clarifies that provision of family physical separation and only limited planned subrecipients, detailed planning services under Title X may be financial separation.4 This rule will descriptions of the extent of services available under the good reason require Title X providers to maintain and collaboration with subrecipients, exception at the discretion of the project physical and financial separation from and a clear explanation of how the director for women denied coverage for locations which provide abortion as a applicant, if successful, would conduct contraceptives if the sponsor of their method of family planning. an oversight program with respect to its health plan exercises a religious or Together, these changes address subrecipients.5 The final rule defines a moral exemption recognized by the several concerns of the Department.