Department of Health & Human Services

Office of the Secretary

Assistant Secretary for Health
Office of Public Health and Science
Office of Population Affairs
Washington, D.C. 20201

Date: January 12, 1999

From: Deputy Assistant Secretary for Population Affairs

Subject: OPA Program Instruction Series, OPA 99-1: Compliance with
State Reporting Laws

To: Regional Health Administrators, Regions I-X

The Fiscal Year 1999 Omnibus Appropriations bill (P.L. 105-277)
contains new language governing the use of Title X funds. Specifically
section 219 states,

Notwithstanding any other provision of law, no provider of services
under title X of the Public Health Service Act shall be exempt
from any State law requiring notification, or reporting of child
abuse, child molestation, sexual abuse, rape, or incest.

This memorandum is intended to serve as a formal notice to the regional
offices, as well as Title X grantees, concerning compliance with State
reporting laws. A copy of this memorandum should be provided to all
Title X grantees in your region, and Title X providers should refer to
this memorandum as needed, if questions in this area arise.

The language of section 219 means that Title X providers must report
such incidents to the appropriate State authority in accordance with
requirements imposed by State laws. The reporting and notification
requirements referenced in section 219 concern State laws; the authority
to enforce compliance with such laws lies with the States. It is therefore
important that grantees review and be familiar with the relevant reporting
requirements in their individual State. Because State laws vary, it is not
possible for this office to provide more specific guidance as to the
requirements of particular States' laws; grantees are urged to consult
with their own attorneys for specific guidance.

Identified instances of child abuse, child molestation, sexual abuse, rape,
or incest present serious medical and psychological situations for patients
and their families. Findings of such instances coming within the applicable
State law should be documented in the medical record and reported as
required by the applicable State requirements. The Office of Population
Affairs encourages efforts to augment existing training programs for Title
X providers to ensure optimal medical assistance in such situations. Grantees
should fully understand their obligations under State law related to reporting
when such acts or actions are disclosed, and they should review current
protocols for responding to such reports. We also encourage enhanced
counseling and education efforts targeted to the unique needs of adolescents.
Title X providers are encouraged to continue to work at the local level in
an interdisciplinary manner with other local health care providers who may
also have reporting obligations under State law, law enforcement officials,
child protective services, social service experts and others in order to
explore how best to respond to these situations. To accomplish this, regional
offices and Title X grantees are encouraged to utilize resources available
through the regional training centers and the technical assistance contractor,
as well as other available resources.

We appreciate your continued cooperation in assuring that grantees are aware
of their obligations and hope this memorandum provides clarification on
this matter.

/s/
Denese Shervington, M.D., M.P.H.

cc: Regional Program Consultants, Regions I-X