Title X Program Expectations

Title X Program Handbook

The Title X Program Handbook provides information critical to managing a Title X project in one place and serves as a one-stop reference document for new and existing Title X recipients. It provides key information and resources that will help recipients and subrecipients be successful as they implement their Title X projects. This document does not provide guidance on expectations in areas beyond Title X or outside the Office of Population Affairs' (OPA) oversight authority, and does not supersede statute, regulations, legislative mandates, the Notice of Award, or HHS policy.

The information included in the Title X Program Handbook applies to all entities that receive federal award funds under section 1001 of the PHS Act (42 U.S.C. § 300), including Title X recipients, subrecipients and service sites operating under the Title X recipient project, to assist in the establishment and operation of voluntary family planning projects. The Title X Program Handbook includes information and references current as of the date of publication and may be updated as needed in the future.

Title X Program Review Tool

OPA conducts program reviews to ensure grant recipient compliance, the provision of high-quality clinical care, and Title X program integrity. This Title X Program Review Tool is intended for use by OPA staff and consultants to conduct program reviews. It can also be used by Title X grant recipients as a self-assessment and be adapted for use by Title X grant recipients for monitoring their subrecipients and service sites.

Title X Program Fiscal Years 2022-2026 Priorities

OPA program priorities listed below represent Title X’s overarching goals and were included in the PA-FPH-22- 001 notice of funding opportunity (NOFO). This announcement funds Title X service delivery grants that began on April 1, 2022, for an up to five-year project period. Title X is and should be the gold standard of high-quality family planning and sexual and reproductive healthcare. Therefore, as stated in regulation, Title X projects must ensure that services are provided in a manner that is client-centered, culturally and linguistically appropriate, inclusive, and trauma-informed; protects the dignity of the individual; and ensures equitable and quality service delivery consistent with nationally recognized standards of care.

Advance Health Equity through the Delivery of Title X Services

Health equity is when all persons have the opportunity to attain their full health potential, and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances. Advancing equity for all, including people from low-income families, people of color, and others who have been historically underserved, marginalized, and adversely affected by persistent poverty and inequality, is a priority for HHS, OPA, and Title X. By focusing on advancing equity in Title X, we can create opportunities to support communities that have been historically underserved, which benefits everyone. Recipients are expected to ensure that the predominantly low-income clients who rely on Title X services as their usual source of medical care have access to the same quality healthcare, including full medical information and referrals, that higher-income clients and clients with private insurance are able to access. Key strategies for advancing equity include, but are not limited to, removing barriers to accessing services, improving the quality of services, and providing services that are client centered.

Expand Access

Improving and expanding accessibility of services for all clients, especially low-income clients, means providing client-centered services that are available when and where clients need them and can most effectively access them. Recipients are expected to implement their projects in ways that make services as accessible as possible for clients and are responsive to the diverse needs of the clients and communities served. This includes, but is not limited to, the location of services, hours of services, modality of service provision (e.g., in-person, telehealth, drive-thru, mobile clinics), availability of ancillary services such as translation services and referral linkages, robust education and community outreach, ensuring access to a broad range of acceptable and effective family planning methods and services at service sites, and implementing billing and payment practices that expand access to services.

Deliver High-Quality Care

Title X recipients are expected to provide quality family planning services that are consistent with Providing Quality Family Planning Services (QFP) and other relevant nationally recognized standards of care. Quality healthcare is safe, effective, client-centered, timely, efficient, and equitable. Furthermore, client-centered care is respectful of, and responsive to, individual client preferences, needs, and values and where client values guide all clinical decisions. Recipients and their subrecipients are expected to have the capacity to support implementation of nationally recognized standards of care and provide initial and ongoing training and professional development for their staff on these standards.