PKG00261954-instructions.pdf

DEPARTMENT OF

HEALTH AND HUMAN SERVICES

OFFICE OF THE

ASSISTANT SECRETARY FOR HEALTH

Office of Population Affairs

Funding Opportunity: FY2020 Title X Services Grants: Providing

Publicly-Funded Family Planning Services in Areas of High Need

Opportunity Number: PA-FPH-20-001

Application Due Date:

Tuesday, July 28, 2020 6:00 PM Eastern

OVERVIEW

FEDERAL AGENCY NAME

Office of the Assistant Secretary for Health / Office of Population Affairs

FUNDING OPPORTUNITY TITLE

FY2020 Title X Services Grants: Providing Publicly-Funded Family Planning Services in

Areas of High Need

ACTION

Notice

ANNOUNCEMENT TYPE

Initial Competitive Grant

FUNDING OPPORTUNITY NUMBER

PA-FPH-20-001

CFDA NUMBER AND PROGRAM:

93.217 Family Planning Services

DATES

Application Deadline: Tuesday, July 28, 2020 by 6:00 PM Eastern.

Technical Assistance: Webinar, Wednesday, June 10, 2020 at 3:00 PM Eastern.

EXECUTIVE SUMMARY

The Office of Population Affairs announces the availability of funds for Fiscal Year (FY)

2020 grant awards under the authority of Title X of the Public Health Service Act.

On February 14, 2020, the U.S. District Court for the District of Maryland issued a permanent injunction against enforcing the 2019 Title X Final Rule in the State of Maryland only.

Therefore, applicants proposing to provide services in Maryland, need to submit an application under the programmatic guidance in the FY 2019 Title X Family Planning Services Funding

Opportunity Announcement (FOA), which was posted on November 7, 2018 and revised January

15, 2019 when the 2019 Title X Final Rule was not yet in effect. The FY 2019 Title X Family

Planning Services FOA,1 revised for dates and other grants management requirements, can be found on grants.gov under announcement number PA-FPH-20-002. Because of this permanent injunction, all services provided in Maryland must be in compliance with the previous regulations until further notice.

Applications under this notice and the Maryland Service Area Only notice (PA-FPH-20-

002) will be reviewed under the respective review criteria of each notice, and ranked in a single list for funding consideration. FY 2020 grant awards under the authority of Title X of the Public

Health Service Act (i.e., this notice and PA-FPH-20-002) will be awarded based on the need of the applicants for Title X funding overall.

This notice solicits applications for projects from entities throughout the 50 United States, District of Columbia, Commonwealth of Puerto Rico, U.S. Virgin Islands, and Commonwealth of the Northern Mariana Islands, American Samoa, Guam, Republic of Palau, Federated States of

Micronesia, and the Republic of the Marshall Islands (hereafter, States) to expand voluntary family planning services in areas that are currently unserved and/or underserved by the Title X network in all service areas other than Maryland. For applicants proposing to provide services in Maryland, applications must be submitted under notice PA-FPH-20-002.

Approximately $18 million is available for competing grants throughout the States.

Between the two notices, the Office of Population Affairs (OPA) intends to fund an estimated 10 grants between $250,000 to $4 million each annually for up to two years to public and/or nonprofit

1 The original posting of PA-FPH-19-001 is available on grants.gov at https://www.grants.gov/web/grants/view-opportunity.html?oppId=308947 private entities to assist in the establishment and operation of voluntary family planning projects which shall offer a broad range of acceptable and effective family planning methods and services, including fertility awareness-based methods (previously referred to as natural family planning), infertility services, and services for adolescents.

All activities funded under this announcement must be in compliance with requirements of the Title X statute, any legislative mandates, and any program regulations, as of the time the requirement is applicable and in effect. Applicants may download copies of the Title X statute, regulations, and legislative mandates from the Office of Population Affairs web site at https://www.hhs.gov/opa/title-x-family-planning/about-title-x-grants/index.html. On March 4, 2019, HHS issued a Final Rule to revise the regulations that govern the Title X family planning program. This Rule, entitled “Compliance with Statutory Program Integrity Requirements,” was published in the Federal Register at 84 Fed. Reg. 7714 and is available in its entirety at https://www.federalregister.gov/documents/2019/03/04/2019-03461/compliance-with-statutory-program-integrity-requirements. In addition, the Title X regulations, 42 C.F.R. Part 59, Subpart

A, are attached to this Funding Opportunity Announcement at Appendix B (and also available at https://www.ecfr.gov/cgi-bin/text-idx?SID=beacfd044d5a71d9fdb2a76300994972&mc=true&node=sp42.1.59.a&rgn=div6.)

HHS/OASH encourages applicants to review all program requirements, eligibility information, application format and submission information, evaluation criteria, and other information in this funding announcement to ensure that its application complies with all requirements and instructions.

https://www.hhs.gov/opa/title-x-family-planning/about-title-x-grants/index.html https://www.federalregister.gov/documents/2019/03/04/2019-03461/compliance-with-statutory-program-integrity-requirements https://www.federalregister.gov/documents/2019/03/04/2019-03461/compliance-with-statutory-program-integrity-requirements https://www.ecfr.gov/cgi-bin/text-idx?SID=beacfd044d5a71d9fdb2a76300994972&mc=true&node=sp42.1.59.a&rgn=div6 https://www.ecfr.gov/cgi-bin/text-idx?SID=beacfd044d5a71d9fdb2a76300994972&mc=true&node=sp42.1.59.a&rgn=div6

FUNDING OPPORTUNITY DETAILS

A. DATES

1. Application Deadline

Your application is due Tuesday, July 28, 2020 by 6 p.m. Eastern Time. To receive consideration, you must submit your application electronically via Grants.gov no later than this due date and time. If you do not submit your application by the specified deadline, we will return it to you unread. You must submit electronically via Grants.gov unless you obtain a written exemption from this requirement 2 business days in advance of the deadline from the Director, HHS/Office of the Assistant Secretary for Health (OASH) Grants and Acquisitions Management

(GAM) Division. To obtain an exemption, you must request one via email from the HHS/OASH

GAM, and provide details as to why you are technologically unable to submit electronically through Grants.gov. Your request should be submitted at least 4 business days prior to the application deadline to ensure your request can be considered prior to 2 business days in advance of the deadline. If you request an exemption, include the following in your e-mail request: the

HHS/OASH announcement number; your organization's DUNS number; your organization’s name, address and telephone number; the name and telephone number of your Authorizing

Official; the Grants.gov Tracking Number (for example, GRANT####) assigned to your submission; and a copy of the "Rejected with Errors" notification from Grants.gov. Send the request with supporting documentation to OASH_Grants@hhs.gov. Note: failure to have an active

System for Account Management (SAM) registration prior to the application due date will not be grounds for receiving an exemption to the electronic submission requirement. As a result of the public health emergency for COVID-19, the requirement for an active SAM registration at the time of application submission has been waived (see Section F.4). However, if you do not have a mailto:ogm.oash@hhs.gov

DUNS number at this time, you should contact the Grants.gov to establish a temporary DUNS number. Your application will not be accepted through Grants.gov without this number. Failure to follow Grants.gov instructions to ensure software compatibility will not be grounds for receiving an exemption to the electronic submission requirement.

The HHS/OASH GAM will only accept applications via alternate methods (hardcopy paper via U.S. mail or other provider or PDF via email) from applicants obtaining prior written approval.

If you receive an exemption, you must still submit your application by the deadline. Only applications submitted through the Grants.gov portal or alternate format (hardcopy paper via U.S.

mail or other service or PDF via email) with an approved written exemption will be accepted. See

Section F.8 (“Other Submission Requirements”) for information on application submission mechanisms.

Executive Order 12372 comment due date: The State Single Point of Contact (SPOC) has

60 days from the application due date to submit any comments. For more information on the SPOC see section F.6 Intergovernmental Review.

To ensure adequate time to submit your application successfully, HHS/OASH recommends that you register as early as possible in Grants.gov since the registration process can take up to one month. You must register an authorizing official for your organization. HHS/OASH does not determine your organization’s authorizing official; your organization makes that designation. For information on registering for Grants.gov, refer to http://www.grants.gov or contact the Grants.gov

Contact Center 24 hours a day, 7 days a week (excluding Federal holidays) at 1-800-518-4726 or support@grants.gov.

Your organization is strongly encouraged to register multiple authorized organization representatives in Grants.gov to ensure someone is available to submit your application.

http://www.grants.gov/ mailto:support@grants.gov

2. Technical Assistance

A technical assistance webinar for potential applicants will be held on Wednesday, June

10, 2020 at 3:00 PM Eastern. Log-in information and additional details will be posted on the OPA website at https://www.hhs.gov/opa/grants-and-funding/index.html.

We recommend you review the entire announcement promptly so you can have any questions answered well in advance of the application due date. We also recommend you subscribe to this announcement in Grants.gov so you receive any amendments, question and answer documents, or other updates.

B. PROGRAM DESCRIPTION:

The Office of the Assistant Secretary for Health, Office of Population Affairs announces the availability of funds for Fiscal Year (FY) 2020 grant awards under the authority of Title X of the Public Health Service Act. The Office of Population Affairs (OPA) promotes health across the reproductive lifespan through innovative, evidence-based adolescent health and family planning programs, services, strategic partnerships, evaluation, and research. OPA administers the

Title X program, the Teen Pregnancy Prevention Program, and the Embryo Adoption Awareness program. OPA advises the Secretary of HHS and Assistant Secretary for Health on a wide range of topics, including adolescent health, family planning, sterilization, and other population issues.

Through its mission and related work, OPA supports the Office of the Assistant Secretary for

Health (OASH) in its mission to advance health equity and improve the health of all people.

1. Background

Under this announcement approximately $18,000,000 is available on a competitive basis to public and private nonprofit entities to expand voluntary family planning services projects https://www.hhs.gov/opa/grants-and-funding/index.html throughout the States. Family planning includes a broad range of services related to achieving and preventing pregnancy, assisting women, men, and couples with achieving their desired number and spacing of children. Section 1001 of Title X of the Public Health Service Act, as amended, authorizes grants “to assist in the establishment and operation of voluntary family planning projects which shall offer a broad range of acceptable and effective family planning methods and services (including natural family planning methods, infertility services, and services for adolescents).” Natural family planning methods are now referred to as fertility awareness-based methods.

OPA encourages applications that would meet the needs of populations in geographical areas with populations underserved or unserved by the Title X family planning network where family planning services are currently limited or not available. Currently, there are geographical gaps in the availability and coverage of Title X family planning services. The following states have no active Title X family planning coverage/service sites: Maine, Oregon, Utah, Vermont, Hawaii, and Washington. Additionally, Alaska, Connecticut, Illinois, Maryland, Massachusetts, Minnesota, New Hampshire, and New York have limited Title X coverage/service sites.

Applicants may propose to serve additional unserved and/or underserved areas within a currently funded State or in other States, or may propose to expand services to reach additional underserved areas within the service area of a current Title X grant. The amount requested for funding should be based on the total number of women in need of publically funded contraceptive services2 proposed to be served as part of the project. According to the most recent FPAR data, the current average cost for Title X grantees is $335/family planning user or $204/family planning encounter.

2 This site (https://data.guttmacher.org/states) may provide guidance to identify the number of women in need of publicly funded contraceptive services for each state. Information is available by county within each state.

https://data.guttmacher.org/states

Applicants should provide a rationale for the costs expected per user and per encounter. Projects shall provide family planning services to all persons desiring such services, with priority for services to persons from low-income families.

An applicant may propose a family planning service project that either is comprised of a single provider or a group of partnering providers who deliver coordinated and comprehensive family planning services. An applicant that will not provide all services directly must document the process and criteria it will use for selecting subrecipients, as well as a plan to monitor their performance. The applicant will take into consideration the extent to which the subrecipient(s) indicates it can provide the required services and best serve individuals in need throughout the proposed service area (or part thereof). If an applicant plans to only provide a limited range of family planning methods, they must select subrecipients who offer additional family planning methods or act as a subrecipient for another applicant. In order to fulfill the requirements in the

Title X statute, the project, made up of the applicant, and any subrecipients, must provide a broad range of family planning methods to clients throughout the proposed service area. A broad range of family planning services should include several categories of methods, such as: abstinence counseling, hormonal methods (oral contraceptives, rings and patches, injection, hormonal implants, intrauterine devices or systems), barrier methods (diaphragms, condoms), fertility awareness-based methods, and permanent sterilization. A “broad range” would not necessarily need to include all categories, but should include hormonal methods since these are requested most frequently by clients and among the methods shown to be most effective in preventing pregnancy.

The application shall ensure that if family planning services are provided by contract or other similar arrangements with actual providers of services, those services will be provided in accordance with a plan which establishes rates and method of payment for medical care. These payments must be made under agreements with a schedule of rates and payment procedures maintained by the applicant. The applicant must be prepared to substantiate that these rates are reasonable and necessary (42 C.F.R. § 59.5(b)(9)).

Family planning services are those services offered to women and men that assist them in preventing or achieving pregnancy. These should be client-centered such that care is respectful of, and responsive to, individual client preferences, needs, and values. Successful Title X projects will provide the following core family planning services:

(a) Discussion with the client about their reproductive life plan.

(https://www.cdc.gov/preconception/planning.html).

(b) A broad range of acceptable and effective family planning methods and services for delaying or preventing pregnancy, which should include:

• Counseling, especially for adolescents, that avoiding sex is the only

100% effective method to prevent pregnancy and STDs; therefore, delaying the onset of sexual activity, or if already sexually active, choosing to avoid sexual activity for a defined period of time, is an option; and

• Instruction in fertility awareness-based methods (previously referred to as natural family planning) that includes staff who are specifically trained in providing instruction in these methods; and,

• Availability of several categories of contraceptive methods, such as:

hormonal methods (oral contraceptives, rings and patches, injection, implants, intrauterine devices or systems), barrier methods (diaphragms, condoms), and/or permanent sterilization.

https://www.cdc.gov/preconception/planning.html

(c) The broad range of family planning services does not include abortion as a method of family planning

(d) Pregnancy testing, and counseling in accordance with the Title X regulations.

(e) Services centered around pre-conception health and achieving pregnancy, which should include:

• Basic infertility services;

• STD prevention education, screening, and treatment;

• HIV testing and referral for treatment when appropriate; and

• Screening for substance use disorders and referral when appropriate to help reduce adverse pregnancy-related outcomes and improve individuals’ reproductive health generally.

Title X projects may also include other reproductive health and related preventive health services that are considered beneficial to reproductive health such as HPV vaccination, provision of HIV pre-exposure prophylaxis (PrEP), breast and cervical cancer screening, and screening for obesity, smoking, drug and alcohol use, mental health, and intimate partner violence.

2. Program Priorities

Title X Priorities include all of the legal requirements covered within the Title X statute, regulations, and legislative mandates. All applicants must comply with the requirements regarding the provision of family planning services that can be found in the statute (Title X of the Public

Health Service Act, 42 U.S.C. § 300 et seq.) and the implementing regulations (42 C.F.R. Part 59, Subpart A). In addition, sterilization of clients as part of the Title X program must be consistent with 42 C.F.R. Part 50, Subpart B (“Sterilization of Persons in Federally Assisted Family Planning

Projects”). Further, FY2020 appropriations language states that funds are available “Provided, that amounts provided to said projects under such title shall not be expended for abortions, that all pregnancy counseling shall be nondirective, and that such amounts shall not be expended for any activity (including the publication or distribution of literature) that in any way tends to promote public support or opposition to any legislative proposal or candidate for public office.”

a. Title X Regulations

Applicants must comply with all of the requirements set out in the Title X implementing regulations at 42 C.F.R. Part 59, Subpart A. To assist applicants with submitting applications that meet the responsiveness criteria in this funding opportunity announcement, we have summarized the provisions below; however, applicants should also review the full-text of this regulation attached at Appendix B (and also available at https://www.ecfr.gov/cgi-bin/text-idx?SID=beacfd044d5a71d9fdb2a76300994972&mc=true&node=sp42.1.59.a&rgn=div6.)

1) Financial Accountability

(a) Any funds granted under 42 C.F.R. Part 59, Subpart A, shall be expended solely for the purpose for which the funds were granted in accordance with the approved application and budget, the Title X implementing regulations, the terms and conditions of the award, and the applicable cost principles prescribed in 45

C.F.R. Part 75, Subpart E. (§ 59.9)

(b) Title X grant funds must be used appropriately. Title X funds shall not be used to build infrastructure for purposes prohibited with Title X funds, such as support for the abortion business of a Title X grantee or subrecipient. Funds shall only be used for the purposes, and in direct implementation of, the funded project, https://www.ecfr.gov/cgi-bin/text-idx?SID=beacfd044d5a71d9fdb2a76300994972&mc=true&node=sp42.1.59.a&rgn=div6 https://www.ecfr.gov/cgi-bin/text-idx?SID=beacfd044d5a71d9fdb2a76300994972&mc=true&node=sp42.1.59.a&rgn=div6 expressly permitted by 42 C.F.R. Part 59, Subpart A, and authorized within section 1001 of the Public Health Service Act, that is, to offer family planning methods and services. Grantees must use the majority of grant funds to provide direct services to clients, and each grantee shall provide a detailed plan or accounting for the use of grant dollars, both in their applications for funding, and in any annually required reporting. Any significant change in the use of grant funds within the grant cycle shall not be undertaken without the approval of the

Office of Population Affairs. (§ 59.18(a)) Title X funds shall not be expended for any activity (including the publication or distribution of literature) that in any way tends to promote public support or opposition to any legislative proposal or candidate for office. (§ 59.18(b)) Additionally, each project supported under Title

X shall fully account for, and justify, charges against the Title X grant. HHS shall put additional protections in place to prevent possible misuse of Title X funds through misbilling or overbilling, or any other unallowable expense. (§ 59.18(c))

2) Provision of Services

(a) A Title X project must provide for medical services related to family planning (including physician's consultation, examination, prescription, and continuing supervision, laboratory examination, contraceptive supplies) and referral to other medical facilities when medically necessary, consistent with §

59.14(a), and provide for the effective usage of contraceptive devices and practices. (§ 59.5(b)(1))

(b) A Title X project must provide a broad range of acceptable and effective family planning methods (including contraceptives, natural family planning or other fertility awareness-based methods) and services (including infertility services, information about or referrals for adoption, and services for adolescents) within the entire Title X project. Entities that provide only one method of family planning can participate as part of a project, as long as the entire project provides a broad range of family planning methods and services. (§ 59.5(a)(1))

(c) A Title X project must provide for social services related to family planning, including counseling, referral to and from other social and medical services agencies, and any ancillary services which may be necessary to facilitate clinic attendance. (§ 59.5(b)(2))

(d) A Title X project must offer either comprehensive primary health services onsite or have a robust referral linkage with primary health providers who are in close physical proximity, to the Title X site, in order to promote holistic health and provide seamless care. (§ 59.5(a)(12))

(e) A Title X project must provide services without the imposition of any durational residency requirement or requirement that the patient be referred by a physician. (§ 59.5(b)(5))

(f) A Title X project must provide that family planning medical services will be performed under the direction of a physician with special training or experience in family planning. (§ 59.5(b)(6))

(g) A Title X project must provide services in a manner which protects the dignity of the individual; without regard to religion, race, color, national origin, handicapping condition, age, sex, number of pregnancies, or marital status; and, without subjecting individuals to any coercion to accept services or to employ or not to employ any particular methods of family planning. Acceptance of services must be solely on a voluntary basis and may not be made a prerequisite to eligibility for, or receipt of, any other services, assistance from or participation in any other program of the applicant.3 (§ 59.5(a)(2)(4))

(h) A Title X project must encourage family participation in the decision to seek family planning services; and, with respect to each minor patient, ensure that the records maintained document the specific actions taken to encourage such family participation (or the specific reason why such family participation was not encouraged). (§ 59.5(a)(14))

(i) A Title X project must provide that all services purchased for project participants will be authorized by the project director or his designee on the project staff. (§ 59.5(b)(7))

(j) A Title X project must, except as provided in § 59.14(a), provide for coordination and use of referral arrangements with other providers of health care services, local health and welfare departments, hospitals, voluntary agencies, and health services projects supported by other federal programs. (§ 59.5(b)(8))

(k) A Title X project must ensure confidentiality of services. All information as to personal facts and circumstances obtained by the project staff about individuals

3 Section 205 of Pub. L. 94-63 states: “Any (1) officer or employee of the United States, (2) officer or employee of any State, political subdivision of a State, or any other entity, which administers or supervises the administration of any program receiving Federal financial assistance, or (3) person who receives, under any program receiving Federal assistance, compensation for services, who coerces or endeavors to coerce any person to undergo an abortion or sterilization procedure by threatening such person with the loss of, or disqualification for the receipt of, any benefit or service under a program receiving Federal financial assistance shall be fined not more than $1,000 or imprisoned for not more than one year, or both.”

receiving services must be held confidential and not be disclosed without the individual's documented consent, except as may be necessary to provide services to the patient or as required by law, with appropriate safeguards for confidentiality; concern with respect to the confidentiality of information, however, may not be used as a rationale for noncompliance with laws requiring notification or reporting of child abuse, child molestation, sexual abuse, rape, incest, intimate partner violence, human trafficking, or similar reporting laws.

Otherwise, information may be disclosed only in summary, statistical, or other form which does not identify particular individuals. (§ 59.11)

(l) A Title X project must provide referral for prenatal care. Because Title X funds are intended only for family planning, once a client served by a Title X project is medically verified as pregnant, she shall be referred to a health care provider for medically necessary prenatal health care. The Title X provider may also choose to provide the following counseling and/or information to her:

(i) Nondirective pregnancy counseling, when provided by physicians or advanced practice providers;

(ii) A list of licensed, qualified, comprehensive primary health care providers (including providers of prenatal care);

(iii) Referral to social services or adoption agencies; and/or

(iv) Information about maintaining the health of the mother and unborn child during pregnancy. (§ 59.14(b)(1))

(m) In cases in which emergency care is required, the Title X project shall only be required to refer the client immediately to an appropriate provider of medical services needed to address the emergency. (§ 59.14(b)(2))

(n) A Title X project must provide priority in the provision of services to persons from low-income families. (§ 59.5(a)(6))

(o) A Title X project must provide services to persons from low-income families at no charge except to the extent that payment will be made by a third party (including a government agency) which is authorized to or is under legal obligation to pay this charge. Projects must charge persons other than those from low-income families for services provided in accordance with a schedule of discounts based on ability to pay, except persons from families whose annual income exceeds 250 percent of the levels set forth in the most recent Poverty

Guidelines issued pursuant to 42 U.S.C. 9902(2), in which case charges will be made in accordance with a schedule of fees designed to recover the reasonable cost of providing services. If a third party (including a Government agency) is authorized or legally obligated to pay for services, all reasonable efforts must be made to obtain the third-party payment without application of any discounts.

Where the cost of services is to be reimbursed under title XIX, XX, or XXI of the

Social Security Act, a written agreement with the title XIX, XX or XXI agency is required. (§ 59.5(a)(7–9)).

(p) A Title X project director may find that low income family also includes members of families whose annual income exceeds 100% of the most recent

Poverty Guidelines, but who, as determined by the project director, are unable, for good reasons, to pay for family planning services. For example:

(i) Unemancipated minors who wish to receive services on a confidential basis must be considered on the basis of their own resources, provided that the Title X provider has documented in the minor's medical records the specific actions taken by the provider to encourage the minor to involve her/his family (including her/his parents or guardian) in her/his decision to seek family planning services, except that documentation of such encouragement is not to be required if the Title X provider has documented in the medical record:

• That it suspects the minor to be the victim of child abuse or incest; and

• That it has, consistent with, and if permitted or required by, applicable

State or local law, reported the situation to the relevant authorities.

(ii) For the purpose of considering payment for contraceptive services only, where a woman has health insurance coverage through an employer that does not provide the contraceptive services sought by the woman because the employer has a sincerely held religious or moral objection to providing such coverage, the project director may consider her insurance coverage status as a good reason why she is unable to pay for contraceptive services. In making that determination, the project director must also consider other circumstances affecting her ability to pay, such as her total income. (§ 59.2)

(q) If family planning services are provided by contract or other similar arrangements with actual providers of services, services will be provided in accordance with a plan which establishes rates and method of payment for medical care. These payments must be made under agreements with a schedule of rates and payment procedures maintained by the grantee. The grantee must be prepared to substantiate, that these rates are reasonable and necessary.

(§ 59.5(b)(9))

3) Prohibitions on Abortion

(a) A Title X project may not perform, provide, promote, refer for, or support abortion as a method of family planning, nor take any other affirmative action to assist a patient to secure such an abortion. (§§ 59.5(a)(5); 59.14(a)) A project may not receive Title X funds unless the grantee provides assurance that the project does not provide abortion and does not include abortion as a method of family planning and will comply with §§ 59.13-59.16 of the regulation. A Title

X project must comply with these requirements at all times during the project period. (§ 59.13).

(b) A Title X project may not encourage, promote or advocate abortion as a method of family planning. This restriction prohibits actions in the funded project that assist women to obtain abortions for family planning purposes or to increase the availability or accessibility of abortion for family planning purposes.

Prohibited actions include the use of Title X project funds for the following:

(i) Lobbying for the passage of legislation to increase in any way the availability of abortion as a method of family planning;

(ii) Providing speakers or educators who promote the use of abortion as a method of family planning;

(iii) Attending events or conferences during which the grantee or subrecipient engages in lobbying;

(iv) Paying dues to any group that, as a more than insignificant part of its activities, advocates abortion as a method of family planning and does not separately collect and segregate funds used for lobbying purposes;

(v) Using legal action to make abortion available in any way as a method of family planning; and

(vi) Developing or disseminating in any way materials (including printed matter, audiovisual materials and web-based materials) advocating abortion as a method of family planning. (§ 59.16(a))

(c) A Title X project may not use the provision of any prenatal, social service, emergency medical, or other referral, of any counseling, or of any provider lists, as an indirect means of encouraging or promoting abortion as a method of family planning. The list of licensed, qualified, comprehensive primary health care providers (including providers of prenatal care) may be limited to those that do not provide abortion, or may include licensed, qualified, comprehensive primary health care providers (including providers of prenatal care), some, but not the majority, of which also provide abortion as part of their comprehensive health care services. Neither the list nor project staff may identify which providers on the list perform abortion. (§ 59.14(c))

(d) A Title X project must be organized so that it is physically and financially separate from activities which are prohibited under section 1008 of the Public

Health Service Act and §§ 59.13, 59.14, and 59.16 of these regulations from inclusion in the Title X program. In order to be physically and financially separate, a Title X project must have an objective integrity and independence from prohibited activities. Mere bookkeeping separation of Title X funds from other monies is not sufficient. (§ 59.15) Factors that are relevant to HHS’s determination as to whether a Title X project has an objective integrity and independence from prohibited activities are included in 42 C.F.R. § 59.15(a)-(d).

See the full text of the regulation attached at Appendix B and also available at https://www.ecfr.gov/cgi-bin/textidx?SID=beacfd044d5a71d9fdb2a76300994972&mc=true&node=sp42.

1.59.a&rgn=div6

4) Subrecipient monitoring

(a) A Title X project must ensure transparency in the delivery of services by reporting the following information in the grant application and in all subsequent reports:

https://www.ecfr.gov/cgi-bin/textidx?SID=beacfd044d5a71d9fdb2a76300994972&mc=true&node=sp42.1.59.a&rgn=div6 https://www.ecfr.gov/cgi-bin/textidx?SID=beacfd044d5a71d9fdb2a76300994972&mc=true&node=sp42.1.59.a&rgn=div6 https://www.ecfr.gov/cgi-bin/textidx?SID=beacfd044d5a71d9fdb2a76300994972&mc=true&node=sp42.1.59.a&rgn=div6

(i) Subrecipients and agencies or individuals providing referral services by name, location, expertise and services provided or to be provided;

(ii) Detailed description of the extent of the collaboration with subrecipients, referral agencies, and any individuals providing referral services, in order to demonstrate a seamless continuum of care for clients; and

(iii) Clear explanation of how the grantee will ensure adequate oversight and accountability for quality and effectiveness of outcomes among subrecipients. (§ 59.5(a)(13))

(b) Unless otherwise specified, the requirements imposed by 42 C.F.R. Part 59, Subpart A, apply equally to grantees and subrecipients, and grantees shall require and ensure that subrecipients (and the subrecipients of subrecipients) comply with the requirements contained in these regulations pursuant to their written contracts with such subrecipients. Additionally, except for 42 C.F.R. §§59.4, 59.8, and

59.10 (see Appendix B), the Title X implementing regulations are also applicable to the execution of contracts under section 1001 of the Public Health Service Act

(42 U.S.C. 300). (§ 59.1(a) and (b))

5) Community Engagement, Information and Education

(a) A Title X project must provide an opportunity for maximum participation by existing or potential subrecipients in the ongoing policy decision-making of the project. (§ 59.5(a)(10)) Provide, to the maximum feasible extent, an opportunity for participation in the development, implementation, and evaluation of the project by persons broadly representative of all significant elements of the population to be served, and by others in the community knowledgeable about the community's needs for family planning services. (§ 59.5(b)(10))

(b) A Title X project must provide for informational and educational programs designed to—

(i) Achieve community understanding of the objectives of the program;

(ii) Inform the community of the availability of services; and

(iii) Promote continued participation in the project by persons to whom family planning services may be beneficial. (§ 59.5(b)(3))

(c) A Title X project must provide a satisfactory assurance that the project shall use an Advisory Committee to review and approve informational and educational materials developed or made available under the project prior to their distribution, to assure that the materials are suitable for the population or community to which they are to be made available and the purposes of Title X. The project must not disseminate any such materials which are not approved by the Advisory

Committee. (§§ 59.5(a)(11); 59.6(a)) Guidelines for establishing the Advisory

Committee are included in 42 C.F.R. § 59.6(b). See the full text of the regulation attached at Appendix B and also available at https://www.ecfr.gov/cgi-bin/textidx?SID=beacfd044d5a71d9fdb2a76300994972&mc=true&node=sp42.

1.59.a&rgn=div6

6) Compliance & Staff Training

(a) A Title X project must provide for orientation and in-service training for all project personnel. (§ 59.5(b)(4))

(b) A Title X project must comply with all State and local laws requiring notification or reporting of child abuse, child molestation, sexual abuse, rape, incest, intimate partner violence or human trafficking (collectively, “State notification laws”). (§ 59.17(a)) A project may not receive funds unless it provides appropriate documentation or other satisfactory assurance that it:

(i) Has in place and implements a plan to comply with State notification laws. Such plan shall include, at a minimum, policies and procedures that include:

• A summary of obligations of the project or organizations and individuals carrying out the project under State notification laws, including any obligation to inquire about or determine the age of a minor client or of a minor client's sexual partner(s);

• Timely and adequate annual training of all individuals (whether or not they are employees) serving clients for, or on behalf of, the project regarding State notification laws; policies and procedures of the Title X project and/or provider with respect to notification and reporting of child abuse, child molestation, sexual abuse, rape, incest, intimate partner violence and human trafficking; appropriate interventions, strategies, and referrals to improve the safety and current situation of the patient; and compliance with State notification laws.

• Protocols to ensure that every minor who presents for treatment is provided counseling on how to resist attempts to coerce them into engaging in sexual activities; and

• Commitment to conduct a preliminary screening of any minor who presents with a sexually transmitted disease (STD), pregnancy, or any suspicion of abuse, in order to rule out victimization of a minor. Projects are permitted to diagnose, test for, and treat STDs. (§ 59.17(b)(1))

(ii) Maintains records to demonstrate compliance with each of the requirements included in bullet (i) above, including which:

• Indicate the age of minor clients;

• Indicate the age of the minor client's sexual partners if such age is an element of a State notification law under which a report is required; and

• Document each notification or report made pursuant to such State notification laws. (§ 59.17(b)(2))

b. Legislative Mandates

The following legislative mandates have been part of the Title X appropriations language for a number of years. Title X family planning services should include administrative, clinical, counseling, and referral services as well as training of staff necessary to ensure adherence to these requirements.

• “None of the funds appropriated in this Act may be made available to any entity under Title X of the PHS Act unless the applicant for the award certifies to the Secretary of Health and Human Services that it encourages family participation in the decision of minors to seek family planning services and that it provides counseling to minors on how to resist attempts to coerce minors into engaging in sexual activities;” and

• “Notwithstanding any other provision of law, no provider of services under Title X of the PHS Act shall be exempt from any State law requiring notification or the reporting of child abuse, child molestation, sexual abuse, rape, or incest.”

c. Key Issues

While the requirements derived from statute, regulations, and legislative mandates described above are program priorities, there are additional key issues that represent overarching goals for the Title X program. These are determined based on priorities set by the Office of the Assistant

Secretary of Health (OASH) and the Office of the Secretary (OS) of the Department of Health and

Human Services (HHS). Applicants should provide documentation of how they will address these key issues in their application. The FY 2020 key issues are as follows:

(a) Assuring innovative quality family planning and related preventive health services that lead to improved reproductive health outcomes and overall optimal health, which is defined as a state of complete physical, mental and social well-being and not merely the absence of disease. Guidance regarding the delivery of quality family planning services, as applicable, is spelled out in the April 25, 2014, MMWR, Providing

Quality Family Planning Services: Recommendations of CDC and the U.S. Office of

Population Affairs - PDF. Periodic updates have been made to this publication and are available at https://www.hhs.gov/opa/guidelines/clinical-guidelines/index.html. It is expected that the core family planning services listed in the Program Description, and https://www.cdc.gov/mmwr/pdf/rr/rr6304.pdf https://www.cdc.gov/mmwr/pdf/rr/rr6304.pdf https://www.cdc.gov/mmwr/pdf/rr/rr6304.pdf https://www.hhs.gov/opa/guidelines/clinical-guidelines/index.html which also are included in the Quality Family Planning Services document referenced above, will be provided by each project;

(b) Providing the tools necessary for the inclusion of substance abuse disorder screening into family planning services offered by Title X applicants;

(c) Following a model that promotes optimal health outcomes for the client (physical, mental and social health) by emphasizing comprehensive primary health care services, along with family planning services preferably in the same location or through nearby referral providers;

(d) Providing resources that prioritize optimal health outcomes (physical, mental, and social health) for individuals and couples with the goal of healthy relationships and stable marriages as they make decisions about preventing or achieving pregnancy;

(e) Providing counseling for adolescents that encourages sexual risk avoidance by delaying the onset of sexual activity as the healthiest choice, and developing tools to communicate the public health benefit and protective factors for the sexual health of adolescents found by delaying the onset of sexual activity thereby reducing the overall number of lifetime sexual partners;

(f) Communicating the growing body of information for a variety of fertility awareness-based methods of family planning and providing tools for applicants to use in patient education about these methods;

(g) Fostering interaction with community and faith-based organizations to develop a network for client referrals when needs outside the scope of family planning are identified;

(h) Accurately collecting and reporting data, such as the Family Planning Annual

Report (FPAR), for use in monitoring performance and improving family planning services;

(i) Promoting the use of a standardized instrument, such as the OPA Program

Review Tool, to regularly perform quality assurance and quality improvement activities with clearly defined administrative, clinical, and financial accountability for applicants and subrecipients; and

(j) Increasing attention to CDC screening recommendations for chlamydia and other

STDs (as well as HIV testing) that have potential long-term impact on fertility and pregnancy.

Additionally, applicants should review information on Ending the HIV Epidemic: A Plan for

America. Applicants should provide documentation of how they might address these key issues in their application.

C. AUTHORITY

Section 1001 of the Public Health Service Act.

D. FEDERAL AWARD INFORMATION

The Office of Population Affairs intends to make funds available for competing grant. We will fund awards in annual increments (budget periods) and generally for a project period up to 2 years, although we may approve shorter project periods. Budget periods may also vary from the estimate indicated below due to timing of award issuance or other administrative factors. Funding https://www.hhs.gov/opa/title-x-family-planning/fp-annual-report/index.html https://www.hhs.gov/opa/title-x-family-planning/fp-annual-report/index.html https://search.hhs.gov/searchblox/opa/index.html?query=title+X+subrecipient+table&HHS=Search&page=1&pagesize=10&sortdir=desc&sort=relevance&adsCname=opa&adsDisplay=true&cname=opa&default=AND&tune=https://www.hhs.gov/blog/2019/02/05/ending-the-hiv-epidemic-a-plan-for-america.html https://search.hhs.gov/searchblox/opa/index.html?query=title+X+subrecipient+table&HHS=Search&page=1&pagesize=10&sortdir=desc&sort=relevance&adsCname=opa&adsDisplay=true&cname=opa&default=AND&tune=https://www.hhs.gov/blog/2019/02/05/ending-the-hiv-epidemic-a-plan-for-america.html for all approved budget periods beyond the first is generally level with the initial award amount and is contingent upon the availability of funds, satisfactory progress of the project, adequate stewardship of Federal funds, and the best interests of the Government.

Award Information

Collectively for both PA-FPH-20-001 (nationwide) and PA-FPH-20-002 (Maryland service area only)

Estimated Federal Funds Available: $18,000,000

Anticipated Number of Awards: 5-10*

Award Ceiling (Federal Funds including indirect costs): $4,000,000 per budget period

Award Floor (Federal Funds including indirect costs):$250,000 per budget period

Anticipated Start Date: September 30, 2020

Estimated Period of Performance: Not to exceed 2 years

Anticipated Initial Budget Period Length: 12 months

Type of Award: Grant

Type of Application Accepted: Electronic via Grants.gov ONLY unless an exemption is granted

*FY 2020 grant awards under the authority of Title X of the Public Health

Service Act (i.e., this notice and PA-FPH-20-002) will be awarded based on the need of the applicants for Title X funding overall.

E. ELIGIBILITY INFORMATION

1. Eligibility Requirements

Any public or private nonprofit entity located in a State (which includes one of the 50

United States, District of Columbia, Commonwealth of Puerto Rico, U.S. Virgin Islands, Commonwealth of the Northern Mariana Islands, American Samoa, Guam, Republic of Palau, Federated States of Micronesia, and the Republic of the Marshall Islands) is eligible to apply for an award under this announcement. Faith-based organizations and American Indian/Alaska

Native/Native American (AI/AN/NA) organizations are eligible to apply for Title X Family

Planning Services grants.

2. Cost Sharing or Matching

Program regulations stipulate that projects must identify additional sources of funding and not rely solely upon Title X grant funds. While there is not a fixed cost-sharing percentage or amount, projects must include financial support from sources other than Title X, such as private funding, state funding, and income from private and public insurance for reimbursable services.

The proposed project’s budgets should reflect financial support in addition to Title X funds on both the Standard Form (SF) 424A, Budget Information, and in the budget justification. The amount and source(s) of these funds must be clearly identified separately from the requested Title

X support as indicated on the SF 424A, as well as on the SF 424, Application for Federal

Assistance. Note: OASH allows program income generated by fees collected to be used for cost sharing. The OASH Office of Grants Management will review applications to ensure that the requested amount of Title X funding is in compliance with this business requirement. The cost sharing requirements outlined above are waived for any grant made to the U.S. Virgin Islands, Commonwealth of the Northern Mariana Islands, American Samoa, Guam, Republic of Palau, Federated States of Micronesia, and the Republic of the Marshall Islands. Although projects are expected to identify additional sources of funding and not solely rely on Title X funds, there is no specific amount or level of financial match requirement for this program.

3. Application Responsiveness Criteria

We will review your application to determine whether it meets the responsiveness criteria below. If your application does not meet the responsiveness criteria, we will disqualify it from the competition; we will not review it beyond the initial screening. The responsiveness criteria are as follows:

The grant applicant…