DEPARTMENT OF HEALTH & HUMAN SERVICES 
Office of the Secretary
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