OMB Grant Rule Rewrite: What It Means for OB/GYNs
acoog advocacy
A federal grant rule rewrite reaches its final stage.
The Office of Management and Budget has proposed the largest revision to federal grant rules since 2013. It reaches maternal health research, conference travel, publication costs, and specialty society dues.
What the proposal would change
Published May 29, 2026. More than 400 pages. Government-wide scope.
The rule rewrites 2 CFR Part 200, the Uniform Guidance governing federal grants, cooperative agreements, and pass-through awards since 2013. It reaches every federal grantmaking agency and every category of recipient: universities, hospitals, research institutions, nonprofits, state and local health departments, professional societies, and individual investigators.
The structural change matters as much as the substance. The proposal reclassifies 2 CFR Subtitle A from non-binding guidance into a binding OMB regulation, renamed the Uniform Grants Regulation. Future OMB amendments would then take effect government-wide on a single date, without each agency writing its own implementing rule.
Political review before award
Implementing Executive Order 14332, the rule adds pre-issuance review of discretionary awards by senior political appointees and narrows the role of scientific peer review in selection.
Discretionary termination
Agencies would terminate an award mid-performance when it no longer effectuates program goals, agency priorities, or the national interest as those exist at the time of termination. The current requirement for an appeals process goes away.
Conference, publication, and dues costs
Conference attendance requires express agency approval in the award terms. Publication costs need case-by-case authorization. Society dues require prior written approval and become unallowable when the organization's primary purpose is issue advocacy.
Foreign collaboration limits
A new section bars award funds, including allocable indirect costs, from supporting collaboration with covered foreign countries or entities, absent a statutory exception or agency-head approval.
Content conditions in every award
Federal funds would not fund, promote, encourage, subsidize, or facilitate diversity, equity, and inclusion practices in violation of federal antidiscrimination law, "gender ideology" as defined in Executive Order 14168, or gender transition assistance for individuals under 19 as defined in Executive Order 14187.
A standalone abortion cost principle
Proposed section 200.477 makes costs associated with elective abortion unallowable across all federal financial assistance, except where federal law expressly authorizes them. Similar restrictions already sit in specific program regulations. This provision moves one into the government-wide cost principles.
Why this matters to ACOOG Members
Federal grant dollars underwrite the evidence base for women's health.
National Institutes of Health investigators, Health Resources and Services Administration maternal health programs, Centers for Disease Control and Prevention surveillance work, and state maternal mortality review committees all operate under 2 CFR Part 200. Termination authority without an appeals process introduces instability into multi-year research on preeclampsia, obstetric hemorrhage, contraception, and maternal morbidity.
The cost provisions reach further into daily practice than the headlines suggest. A physician who funds conference travel through a federal award would need agency approval written into the award terms before attending an annual meeting. Membership dues in a specialty society would need prior written approval. Publication costs would need advance authorization, slowing the path from finding to peer-reviewed literature.
For physicians in academic settings, the expanded pre-award risk review deserves close reading. It broadens agency scrutiny of an applicant's professional and extracurricular affiliations.
Read the source text before you act on any summary
Any 400-page proposed rule invites summary error. Confirm specific provisions against the Federal Register document, and remember OMB retains full discretion to revise the language before issuing a final rule.
Three steps this month
Treat October 1, 2026 as the earliest realistic effective date rather than a confirmed one.
Contact your members of Congress
The comment window has closed. Congressional oversight is the available lever before OMB finalizes the rule. Send a message →
Inventory your exposure
Route the proposal to your institution's grants and contracts office and general counsel. Flag awards with international subawards, conference travel lines, publication budgets, or membership dues.
Track the docket
Follow the rulemaking directly. The final rule's own effective-date language will govern. Docket OMB-2026-0034 →
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Sources: Federal Register document 2026-10817, published May 29, 2026. Congressional Research Service report IN12697. Coalition for Health Funding. Association of American Medical Colleges. Published analyses from Ropes & Gray, Crowell & Moring, Akin, Greenberg Traurig, and Wiley.
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