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FY 2018 Title X Family Planning Services Funding Opportunity Announcement: Questions and Answers

Please read the entire funding opportunity announcement prior to beginning your application.

We encourage you to subscribe to the Funding Opportunity Announcement (FOA) (PA-FPH-18-001) on Grants.gov to receive any updates to the announcement or supporting materials.

  1. What is the basis for the Title X family planning service grant program?

Established in 1970, Title X is governed by statutory language (42 U.S.C. 300 et seq.) and regulations (42 CFR part 59, subpart A). This funding opportunity announcement closely follows the language and intent of the statute, and is consistent with the implementing regulations.

  1. Who may apply? 

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 a grant 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. (See FOA, page 15.)

Though not required, Title X projects are encouraged to collaborate, engage, and partner with nonprofit community- and faith-based organizations when developing applications for their Title X family planning service grant.

  1. How does this funding announcement streamline the process?

Now, there will only be one annual application period, rather than multiple grant funding periods (April and July), simplifying the program implementation. In addition, applicants will no longer be required to submit separate applications if they intend to serve multiple states or regions. They may submit only one application, simplifying the process.

  1. How do I register my organization in the System for Award Management (SAM)?

Applicants registering as a new entity in SAM.gov must provide an original, signed notarized letter stating that they are the authorized Entity Administrator before their registration will be activated. Read the SAM FAQs to learn more about this process. Those with existing SAM registrations should also read about the new process and regularly check their registrations for fraudulent activity and ensure their registration remains active. (See FOA, page 35.)

  1. When is the application due?

All applications are to be submitted through Grants.gov no later than Thursday, May 24, 2018 at 6:00 p.m. Eastern Time. (See FOA, page 1.)

  1. What is the start date for new projects?

Projects have an anticipated start date of September 1, 2018. (See FOA, page 12.)

  1. What is the length of project periods for this grant application? What should be the length of my first-year budget period in the application?

Applicants may apply for whatever project period that they would like. Your application for funding should plan for a 12-month budget period for the first budget period. Should we award shorter budget periods, we will negotiate with potential recipients.

  1. If an applicant submits an application for a project period of three years and nine months, would the last budget period be for a nine-month period and not for a 12-month budget period? And further, would an application be deemed unresponsive if it included budget information and work plans for four years instead of three years and nine months as indicated in the FOA?

The first budget period should encompass 12 months. For ease of programmatic and budgetary development, applicants are permitted to propose 12-month budget periods for each budget period submitted. Applicants are permitted to propose 12-month budget periods for each year of the requested project period. Should we award shorter budget periods, we will negotiate with potential recipients. The final decision regarding the length of the initial budget period and the entire project period will be identified in the Notice of Award. The Notice of Award is the official notification that an application has been approved for funding. Neither the length of the project period nor the amount of funds requested is listed as disqualification criteria.

  1. Will HHS/OASH issue more than one award to service the same area?

HHS/OASH may issue one or multiple Title X family planning service awards for the same geographic area. Please note the geographic distribution of services within the identified service area is an additional factor in funding decisions. (See FOA, pages 44-45.)

  1. Can an applicant apply for a service area that is not the entire state, for example, only the eastern part of the state or even a smaller service area?

Yes, applications for a part of a service may be submitted. Applicants should be very specific in the application regarding the service area as well as the plan for providing services throughout the requested service area, including the project plan and the number of people projected to be reached by their services.

  1. How should FQHCs who use a sliding fee schedule that ends at 200% FPL and charge everyone a nominal fee handle the differences with Title X's requirements of no charge for clients with incomes < 100% FPL (FOA, page 20) and slide to 250% FPL?

Please refer to the HHS Office of Population Affairs Policy Program Notice 2016-11, Title X Program Policy Notice Integrating with Primary Care Providers. This Program Policy Notice clarifies how Title X grantees may remain in compliance with Program Requirements for Title X Funded Family Planning Projects when integrating services with the Health Resources and Services Administration (HRSA) Health Center Program grantees and look-alikes.

  1. For organizations that are young and/or with no previous federal funding, is there anything that would disqualify them from applying or any specific concerns and qualifications for newer organizations?

All organizations that meet the eligibility criteria (FOA, page 15) are encouraged to apply. Applicants should explain their organizational capabilities for managing a project, as well as the scope of their project to show that it is within their capacity to manage the project, in their Project Narrative.

  1. Do I need to have provided family planning, reproductive health, or other related Title X services before to be eligible to apply for or be awarded a Title X family planning service grant?

No, there is not a requirement for previous or direct experience in providing family planning, reproductive health, or Title X services to be awarded a grant. Title X family planning service grants are awarded based on the competitive application process, that is, how the applicant and application addresses the content of the funding opportunity announcement. We encourage new applicants to submit quality and innovative proposals, expanding subrecipient partnerships in novel ways, and extending services to those areas and clients previously unserved or underserved.

All applicants must address the review criteria. (See FOA pages, 43-44.)

  1. Does an applicant have to provide all services specified in the funding opportunity or can they provide just one specific service, for example, only education services?

Applicants are required to provide all required services as outlined in the Title X statute and implementing regulations (42 CFR part 59, subpart A), and to propose projects that will best promote the purposes of section 1001 of Title X of the Public Health Service Act (see FOA, pages 7-8)

  1. If an organization provides only natural family planning, can they submit an application without providing hormonal contraceptives and sterilization services without having a subrecipient who does provide these services?

Applicants that include natural family planning as part of the broad range of family planning services and methods provided are encouraged to apply, but natural family planning or fertility awareness-based methods (FABM) cannot be the only method provided. Applicants who provide only one method of family planning should partner with other organizations that can provide the broad range of family planning methods and services (see FOA, pages 5-9; 16; 21)

  1. Does sterilization have to be provided?

No, but referral for sterilization is required. If Title X funds are used to provide sterilization, the federal sterilization regulations must be followed (42 CFR part 50, subpart B)

  1. Do I need to provide primary care services as part of grant activities?

Title X family planning service sites are not required also to provide primary health care services, other than those related to providing family planning services (for example, cervical cancer and STD screening). While comprehensive primary care providers are eligible and encouraged to apply for a Title X grant under this announcement, primary care services that are not related to providing family planning cannot be provided as part of Title X grant activities. Nevertheless, it is best for patients to have primary care services provided within the same site or for the family planning provider to have robust referral linkages to primary care providers within close proximity to the Title X site. Either of these options helps promote optimal physical, emotional, and social health outcomes, which is the ultimate goal of client-centered care.

  1. Do contraceptive methods and services need to be provided by the grant recipient? Is contraception considered a part of “broad-based” family planning services?

Yes, Title X regulations require that projects must “provide a broad range of acceptable and effective medically approved family planning methods (including natural family planning methods) and services (including infertility services and services for adolescents).” (42 CFR § 59.5(a)(1))  This requirement is based on the statutory requirement that “voluntary family planning projects . . . 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).”  42 U.S.C. § 300(a).

Yes, this funding opportunity announcement requires Title X projects to offer a broad range of voluntary family planning methods and services, including information and education related to family planning, preconception care, contraception, natural family planning, and infertility services. Such methods and services range along a continuum from (1) infertility services to (2) natural family planning and contraception to (3) sterilization, tailored to the unique needs of the individual. This includes all required services as stipulated in 42 CFR § 59.5, which ensure breadth and variety among family planning methods offered. The broad range of services does not include abortion as a method of family planning. Single providers who have developed expertise in one family planning approach or method may be partners in a broader proposal so long as the total proposal offers a broad range of family planning methods.

  1. What is meant by “returning to a sexually risk-free status?”

Returning to a sexually risk-free status means avoiding sexual activities that put an individual at risk for unwanted pregnancy, sexually transmitted infections or other associated risks.

If individuals who are currently choosing to engage in sexual risk behavior avoid future activities that place them at sexual risk, their health will likely be improved and negative risks associated with sex will likely be mitigated. The funding opportunity announcement (FOA) identifies key issues that should be considered in developing the project plan. One key issue is placing a meaningful emphasis on education and counseling that communicates the social science research and practical application of the benefits of avoiding sexual risk or returning to a sexually risk-free status in order to promote optimal health outcomes for all Title X clients.

  1. What is the social science research on the relationship between avoiding sex at an early age and health outcomes?

Avoiding sex at an early age and the related reduction in the number of lifetime partners are protective factors for sexual health. Including a focus in the funding opportunity announcement (FOA) on avoiding sex at an early age places a meaningful emphasis on the holistic and optimal health outcomes of every client.

Studies have found associations between early versus later initiation of sexual activity and a higher number of sexual partners, a higher prevalence of sexually transmitted infections, and higher incidence of teen pregnancy (Kaestle, Halpern et al. 2005; Heywood, Patrick et al. 2015). A qualitative study from 2010 found family planning providers do offer abstinence counseling to adolescents along with information about contraceptives and condoms, with some describing it as “giving teenagers a way to opt out of unwanted sexual activity” (Harper, Henderson et al. 2010) Other studies have found associations between early sexual initiation and decreased educational attainment, economic status, and adult monogamy (Finger 2004; Schvaneveldt 2001; Sabia 2009; Spriggs 2008; Magnussen 2015; Niled 2014; Paik 2011).

The Key Issues listed in the FOA (see FOA, page 11) includes an emphasis on multiple science-informed topics, including sexual delay, which should be addressed as part of the Title X family planning service project. Educational services for adolescents should not normalize sexual risk behaviors, but instead clearly communicate the benefits of delaying sex or returning to a sexually risk-free status.

  1. How can I counsel on being "sexually risk-free" in a family planning setting?

"If requested to provide such information and counseling, provide neutral, factual information and nondirective counseling on each of the options, and referral upon request, except with respect to any option(s) about which the pregnant woman indicates she does not wish to receive such information and counseling." (42 CFR 59.5 (a)(5)(ii))

Title X providers are required to provide neutral, factual, and nondirective counseling. As such, counseling is non-coercive and informative, while prioritizing the needs and wellbeing of the client. A Title X provider should contextualize the services provided by prioritizing a holistic and optimal health focus. A provider, in a clear and transparent manner, shares the risks that may be associated with certain choices and introduce risk-free alternatives. In this way, the counselor encourages client self-awareness and empowers a client to exercise agency by offering a range of options that are consistent with the client’s expressed need, with the obligation to offer options that are more likely to result in optimal health for the client, and with the statutory language governing the Title X program.

The American Academy of Pediatrics (AAP) Committee on Adolescence includes counseling on abstinence as an important component of sexual health care (Ott and Sucato 2014). Some practical tips for counseling within an office-based setting are available (Ott, Labbett et al. 2007).

  1. What is the definition of holistic referenced in the FOA (page, 7)?

The reference to holistic is about the interrelated factors that are important to achieving health that consider the whole person. The World Health Organization in the preamble to their constitution provides a holistic perspective for what we like to call optimal health. It is that state of mental, physical, and social well-being not merely the absence of a disease or infirmity.

  1. Please specify which nationally recognized standards of care are considered acceptable?

"Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs" (QFP) incorporates recommendations for providing family planning clinical services from various federal agencies and professional medical associations. These include, but are not limited to recommendations from:

  • Centers for Disease Control and Prevention (CDC)
  • U.S. Preventive Services Task Force (USPSTF)
  • American Academy of Pediatrics (AAP)
  • American College of Obstetricians and Gynecologists (ACOG)
  • American Society for Reproductive Medicine (ASRM)
  1. Where can I find the Office of Population Affairs (OPA) performance metrics to perform quality assurance and quality improvement activities referenced in the Priorities section on page 10 of the funding opportunity announcement?

The data that grantees submit annually for the Family Planning Annual Report (FPAR) are used to calculate OPA performance measures. Applicants should describe how they are going to use data collected as part of FPAR to improve the quality of care delivered across their project sites.

References

Brittain, A. W., Williams, J. R., Zapata, L. B., Pazol, K., Romero, L. M., & Weik, T. S. (2015). Youth-friendly family planning services for young people: A systematic review. American Journal of Preventive Medicine, 49(2, Suppl. 1), S73–S84. https://doi.org/10.1016/j.amepre.2015.03.019

Finger, R., Thelen, T., Vessey, J. T., Mohn, J. K., & Mann, J. R. (2004). Association of virginity at age 18 with educational, economic, social, and health outcomes in middle adulthood. Adolescent & Family Health, 3(4), 164–170.

Gavin, L., Moskosky, S., Carter, M., Curtis, K., Glass, E., Godfrey, E., et al. (2014). Providing quality family planning services: Recommendations of CDC and the U.S. Office of Population Affairs. Morbidity and Mortality Weekly Report: Recommendations and Reports, 63(RR04), 1–29. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6304a1.htm

Harper, C. C., Henderson, J. T., Schalet, A., Becker, D., Stratton, L., & Raine, T. R. (2010). Abstinence and teenagers: Prevention counseling practices of health care providers serving high-risk patients in the United States. Perspectives on Sexual and Reproductive Health, 42(2), 125–132. https://doi.org/10.1363/4212510

Heywood, W., Patrick, K., Smith, A. M. A., & Pitts, M. K. (2015). Associations between early first sexual intercourse and later sexual and reproductive outcomes: A systematic review of population-based data. Archives of Sexual Behavior, 44(3), 531–569. https://doi.org/10.1007/s10508-014-0374-3

Kaestle, C. E., Halpern, C. T., Miller, W. C., & Ford, C. A. (2005). Young age at first sexual intercourse and sexually transmitted infections in adolescents and young adults. American Journal of Epidemiology, 161(8), 774–780. https://doi.org/10.1093/aje/kwi095

Magnusson, B. M., Nield, J. A., & Lapane, K. L. (2015). Age at first intercourse and subsequent sexual partnering among adult women in the United States, a cross-sectional study. BMC Public Health, 15, 98. https://doi.org/10.1186/s12889-015-1458-2

Nield, J., Magnusson, B. M., Chapman, D. A., & Lapane, K. L. (2014). Age at sexual debut and subsequent sexual partnering in adulthood among American men. American Journal of Men's Health, 8(4), 327–334. https://doi.org/10.1177/1557988313514768

Ott, M. A., Labbett, R. L., & Gold, M. A. (2007). Counseling adolescents about abstinence in the office setting. Journal of Pediatric and Adolescent Gynecology, 20(1), 39–44. https://doi.org/10.1016/j.jpag.2006.10.013

Ott, M. A., Sucato, G. S., & Committee on Adolescence. (2014). Contraception for adolescents. Pediatrics, 134(4), e1257–e1281. https://doi.org/10.1542/peds.2014-2300

Paik, A. (2011). Adolescent sexuality and the risk of marital dissolution. Journal of Marriage and Family, 73(2), 472–485. https://doi.org/10.1111/j.1741-3737.2010.00819.x

Sabia, J. J., & Rees, D. I. (2009). The effect of sexual abstinence on females' educational attainment. Demography, 46(4), 695–715. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2831358/

Schvaneveldt, P. L., Miller, B. C., Berry, E. H., & Lee, T. R. (2001). Academic goals, achievement, and age at first sexual intercourse: Longitudinal, bidirectional influences. Adolescence, 36(144), 767–787.

Spriggs, A. L., & Halpern, C. T. (2008). Timing of sexual debut and initiation of postsecondary education by early adulthood. Perspectives on Sexual and Reproductive Health, 40(3), 152–161. https://doi.org/10.1363/4015208

Content created by Office of Population Affairs
Content last reviewed on April 10, 2018