SENATE BILL 23-288
BY SENATOR(S) Fields and Buckner, Coleman, Cutter, Danielson, Exum,
Ginal, Gonzales, Hansen, Hinrichsen, Jaquez Lewis, Kolker, Marchman,
Moreno, Mullica, Priola, Roberts, Rodriguez, Sullivan, Winter F.,
Zenzinger;
also REPRESENTATIVE(S) English and Joseph, Bacon, Boesenecker,
Brown, deGruy Kennedy, Dickson, Duran, Epps, Froelich, Garcia,
Gonzales-Gutierrez, Hamrick, Herod, Jodeh, Kipp, Lindsay, Lukens,
Mabrey, Marshall, McCormick, McLachlan, Michaelson Jenet, Parenti,
Sirota, Story, Titone, Valdez, Velasco, Weissman, Willford, Woodrow,
Young, McCluskie.
C
ONCERNING MEASURES TO DETERMINE COVERAGE FOR DOULA SERVICES ,
AND, IN CONNECTION THEREWITH, MAKING AN APPROPRIATION.
Be it enacted by the General Assembly of the State of Colorado:
SECTION 1. Legislative declaration. (1) The general assembly
finds and declares that:
(a) There is strong evidence of positive maternal and infant
outcomes associated with doula services;
NOTE: This bill has been prepared for the signatures of the appropriate legislative
officers and the Governor. To determine whether the Governor has signed the bill
or taken other action on it, please consult the legislative status sheet, the legislative
history, or the Session Laws.
________
Capital letters or bold & italic numbers indicate new material added to existing law; dashes
through words or numbers indicate deletions from existing law and such material is not part of
the act. (b) Doula care is associated with a reduction in the number of low
birth weight babies, preterm births, cesarean sections, labor inductions, and
other medical interventions, and is associated with increased rates of
breast-feeding;
(c) Most pregnant persons who utilize doula services have positive
outcomes, and the association between doula support and positive perinatal
outcomes is even stronger for low-income people, people of color, and
people who experience cultural or language barriers to accessing pregnancy
care. However, individuals and families who could benefit the most from
doula services may have the least access to it, financially and culturally.
(d) The United States has the highest rate of maternal mortality
among developed countries, with 1,205 deaths due to maternal causes in
2021;
(e) It is estimated that more than 80 percent of the maternal
mortalities in the United States are preventable;
(f) Data from the Centers for Disease Control and Prevention shows
that nationally, Black pregnant persons are two to three times more likely
to die from pregnancy-related causes than White pregnant persons. There
are between 69 and 70 deaths per 100,000 live births for Black pregnant
persons, compared to between 26 and 27 deaths per 100,000 live births for
White pregnant persons, and 28 deaths per 100,000 live births for Hispanic
pregnant persons.
(g) High rates of maternal mortality among Black pregnant persons
span income and education levels; moreover, risk factors such as a lack of
access to prenatal care and physical health conditions do not fully explain
the racial disparity in maternal mortality;
(h) A growing body of evidence indicates that stress from racism
can result in conditions such as hypertension and preeclampsia that
contribute to poor maternal health outcomes among Black pregnant persons;
(i) In the United States, one in three births is a cesarean section,
which costs about 50 percent more than vaginal births. Studies suggest that
having a doula reduces the need for a cesarean section by 25 percent.
PAGE 2-SENATE BILL 23-288 (j) Currently, 11 states provide medicaid reimbursement for doula
services. Studies in Oregon, Minnesota, and Wisconsin have shown that
when pregnant individuals use a doula, it can save the state money.
(2) Therefore, the general assembly finds that providing doula
services for medicaid recipients in Colorado would significantly improve
health outcomes for pregnant and postpartum individuals and would help
lower the maternal mortality rate in the state.
SECTION 2. In Colorado Revised Statutes, add 25.5-4-506 as
follows:
25.5-4-506. Coverage for doula services - stakeholder process -
federal authorization - scholarship program - training - report -
definitions - repeal. (1) A
S USED IN THIS SECTION, UNLESS THE CONTEXT
OTHERWISE REQUIRES
:
(a) "D
OULA" MEANS A TRAINED BIRTH COMPANION WHO PROVIDES
PERSONAL
, NONMEDICAL SUPPORT TO PREGNANT AND POSTPARTUM PEOPLE
AND THEIR FAMILIES PRIOR TO CHILDBIRTH
, DURING LABOR AND DELIVERY,
AND DURING THE POSTPARTUM PERIOD .
(b) "M
ATERNITY ADVISORY COMMITTEE " MEANS THE COMMITTEE
FACILITATED BY THE STATE DEPARTMENT COMPOSED PREDOMINANTLY OF
BLACK, INDIGENOUS, AND OTHER PEOPLE OF COLOR WITH MATERNITY CARE
EXPERIENCE AS RECIPIENTS
.
(2) N
O LATER THAN SEPTEMBER 1, 2023, THE STATE DEPARTMENT
SHALL INITIATE A STAKEHOLDER PROCESS TO PROMOTE THE EXPANSION AND
UTILIZATION OF DOULA SERVICES FOR PREGNANT AND POSTPARTUM
RECIPIENTS IN THE STATE
. IN CONDUCTING THE STAKEHOLDER PROCESS , THE
STATE DEPARTMENT SHALL
:
(a) D
ESIGN AN OUTREACH STRATEGY THAT INCLUDES BEST
PRACTICES IN COMMUNITY ENGAGEMENT
, INCLUDING, BUT NOT LIMITED TO:
(I) E
NGAGING TRUSTED COMMUNITY PARTNERS TO SUPPORT THE
WORK
;
(II) R
EIMBURSEMENT OF PARTICIPATION COSTS FOR INDIVIDUALS
PAGE 3-SENATE BILL 23-288 WHO ARE NOT OTHERWISE PAID TO PARTICIPATE ;
(III) R
EIMBURSEMENT OF CHILD CARE COSTS FOR INDIVIDUALS WHO
PARTICIPATE
; AND
(IV) TRANSLATION SERVICES AND MEETING TIMES THAT ALLOW
DIVERSE AND INCLUSIVE PARTICIPATION
;
(b) S
OLICIT FEEDBACK RELATED TO:
(I) A
N APPROVED DOULA CERTIFICATION PROCESS THAT
INCORPORATES NATIONAL AND LOCAL TRAINING PROGRAMS
;
(II) A
BILLING PROCESS FOR DOULA SERVICES;
(III) W
AYS TO RECRUIT DOULAS AND INTEGRATE THEM INTO
HOSPITAL DELIVERIES
;
(IV) S
UPPORT NEEDED TO BUILD AND RETAIN A DOULA WORKFORCE ;
(V) C
OMMUNITY OUTREACH TO DETERMINE HOW TO BEST PROMOTE
DOULA SERVICES
; AND
(VI) THE DOULA SCHOLARSHIP PROGRAM CREATED IN SUBSECTION
(7) OF THIS SECTION.
(3) S
TAKEHOLDERS MUST BE DIVERSE WITH REGARD TO RACE ,
ETHNICITY, IMMIGRATION STATUS, SEXUAL ORIENTATION, AND GENDER, AND
MUST REPRESENT OTHER POPULATIONS THAT EXPERIENCE GREATER HEALTH
DISPARITIES AND INEQUITIES
. THE STATE DEPARTMENT MAY INCLUDE THE
FOLLOWING IN THE STAKEHOLDER PROCESS
:
(a) D
OULAS AND POTENTIAL DOULAS WHO MAY SERVE RECIPIENTS
WHO INCLUDE
, BUT ARE NOT LIMITED TO, BLACK, INDIGENOUS, AND OTHER
PEOPLE OF COLOR
, REFUGEES, NON-ENGLISH SPEAKERS, PEOPLE LIVING IN
RURAL AREAS
, AND PEOPLE WHO WERE RECENTLY INCARCERATED ;
(b) I
NDIVIDUALS INDIRECTLY INVOLVED IN THE DELIVERY OF DOULA
SERVICES
, INCLUDING, BUT NOT LIMITED TO , CLINICAL PROVIDERS,
HOSPITALS, MANAGED CARE ENTITIES, AND STATE PARTNERS, INCLUDING,
PAGE 4-SENATE BILL 23-288 BUT NOT LIMITED TO , THE DEPARTMENT OF PUBLIC HEALTH AND
ENVIRONMENT
, DEPARTMENT OF HUMAN SERVICES , DEPARTMENT OF EARLY
CHILDHOOD
, AND DEPARTMENT OF REGULATORY AGENCIES ;
(c) R
EPRESENTATIVES FROM THE DIVISION OF INSURANCE WITH
SUBJECT MATTER EXPERTISE
; AND
(d) REPRESENTATIVES FROM THE MATERNITY ADVISORY COMMITTEE ;
(e) C
ONSUMER ADVOCATES ; AND
(f) EXPERTS ON PERINATAL CARE AND QUALITY .
(4) F
OR STATE FISCAL YEAR 2024-25, THE STATE DEPARTMENT
SHALL SUBMIT A REPORT TO THE GENERAL ASSEMBLY AS PART OF THE STATE
DEPARTMENT
'S "SMART ACT" PRESENTATION REQUIRED BY SECTION
2-7-203. THE REPORT MUST INCLUDE FINDINGS AND RECOMMENDATIONS
FROM THE STAKEHOLDER PROCESS AS DESCRIBED IN SUBSECTION
(2) OF THIS
SECTION
. THE STATE DEPARTMENT SHALL WORK WITH THE MATERNITY
ADVISORY COMMITTEE TO CREATE THE REPORT
.
(5) I
N CARRYING OUT THE STAKEHOLDER PROCESS DESCRIBED IN
SUBSECTION
(2) OF THIS SECTION, THE STATE DEPARTMENT IS EXEMPT FROM
THE
"PROCUREMENT CODE", ARTICLES 101 TO 112 OF TITLE 24.
(6) N
OT LATER THAN JULY 1, 2024, THE STATE DEPARTMENT SHALL
SEEK FEDERAL AUTHORIZATION TO PROVIDE DOULA SERVICES FOR PREGNANT
AND POSTPARTUM PEOPLE TO IMPROVE HEALTH OUTCOMES OF PREGNANT
AND POSTPARTUM PEOPLE WHO FACE A DISPROPORTI ONATELY GREATER RISK
OF POOR BIRTH OUTCOMES
.
(7) (a) N
OT LATER THAN JULY 1, 2024, THE STATE DEPARTMENT
SHALL CREATE A DOULA SCHOLARSHIP PROGRAM THAT GRANTS FUNDS TO
INDIVIDUALS WITHOUT SUFFICIENT FINANCIAL RESOURCES TO COMPLETE
DOULA TRAINING AND CERTIFICATION PROGRAMS NECESSARY TO PROVIDE
DOULA SERVICES
.
(b) I
N DESIGNING THE DOULA SCHOLARSHIP PROGRAM , THE STATE
DEPARTMENT SHALL SOLICIT INPUT FROM GROUPS IDENTIFIED IN SUBSECTION
(3) OF THIS SECTION.
PAGE 5-SENATE BILL 23-288 (c) THE STATE DEPARTMENT SHALL DEFINE ELIGIBILITY CRITERIA FOR
THE DOULA SCHOLARSHIP PROGRAM THAT INCLUDES
, BUT IS NOT LIMITED TO,
THE FOLLOWING:
(I) P
ROOF OF FINANCIAL HARDSHIP;
(II) P
ROOF OF STATE RESIDENCY; AND
(III) A STATEMENT OF INTENT TO SERVE AS A DOULA PROVIDER IN
COLORADO FOR PREGNANT AND POSTPARTUM RECIPIENTS .
(d) T
HE STATE DEPARTMENT SHALL DEFINE CRITERIA FOR
ORGANIZATIONS TO CONDUCT TRAINING AND CERTIFICATION PROGRAMS FOR
DOULAS THAT INCLUDE
, BUT ARE NOT LIMITED TO:
(I) A
N APPROVED CERTIFICATION PROCESS FOR DOULAS ;
(II) A
N EQUITABLE APPROACH TO DOULA RECRUITMENT AND
TRAINING
; AND
(III) AN APPROVED BUDGET TO PROVIDE FREE TRAINING TO
ATTENDEES
.
(e) T
HE STATE DEPARTMENT MAY REQUIRE INDIVIDUALS WHO
RECEIVE SCHOLARSHIP MONEY PURSUANT TO THE DOULA SCHOLARSHIP
PROGRAM DESCRIBED IN THIS SUBSECTION
(7) TO SUBMIT TO THE STATE
DEPARTMENT
, NOT LATER THAN SIX MONTHS AFTER THE INDIVIDUAL 'S
COMPLETION OF DOULA TRAINING OR CERTIFICATION
, DOCUMENTATION
THAT THE INDIVIDUAL IS SERVING AS A DOULA FOR RECIPIENTS OR IS
WORKING TOWARD ENROLLMENT AS A DOULA FOR RECIPIENTS
. IF AN
INDIVIDUAL DOES NOT COMPLETE THE DOCUMENTATION
, THE STATE
DEPARTMENT MAY SEEK REPAYMENT OF THE FUNDS AWARDED TO THE
INDIVIDUAL THROUGH THE DOULA SCHOLARSHIP PROGRAM
.
(f) (I) A
NY MONEY APPROPRIATED TO THE DOULA SCHOLARSHIP
PROGRAM AND NOT EXPENDED PRIOR TO
JULY 1, 2024, IS FURTHER
APPROPRIATED TO THE STATE DEPARTMENT THROUGH
JUNE 30, 2025, TO BE
USED FOR THE SAME PURPOSE
.
(II) T
HIS SUBSECTION (7)(f) IS REPEALED, EFFECTIVE JULY 1, 2026.
PAGE 6-SENATE BILL 23-288 (g) NOTWITHSTANDING SECTION 24-1-136 (11)(a)(I), THE STATE
DEPARTMENT SHALL REPORT ANNUALLY BEGINNING IN
2025 TO THE
GENERAL ASSEMBLY AS PART OF THE STATE DEPARTMENT
'S "SMART ACT"
PRESENTATION, AS REQUIRED BY SECTION 2-7-203, ON THE UTILIZATION AND
OUTCOMES OF THE DOULA SCHOLARSHIP PROGRAM
.
SECTION 3. In Colorado Revised Statutes, add 10-16-155.5 as
follows:
10-16-155.5. Actuarial review of doula services - report -
definition. (1) T
HE DIVISION SHALL CONTRACT WITH AN INDEPENDENT
ENTITY TO CONDUCT AN ACTUARIAL REVIEW OF THE POTENTIAL
HEALTH
-CARE COSTS AND BENEFITS OF INCLUDING COVERAGE FOR DOULA
SERVICES FOR PREGNANT AND POSTPARTUM PERSONS COVERED BY HEALTH
BENEFIT PLANS
.
(2) T
HE DIVISION SHALL PRESENT THE RESULTS FROM THE
ACTUARIAL REVIEW CONDUCTED PURSUANT TO SUBSECTION
(1) OF THIS
SECTION TO THE GENERAL ASSEMBLY AS PART OF THE DIVISION
'S "SMART
A
CT" PRESENTATION REQUIRED BY SECTION 2-7-203 DURING STATE FISCAL
YEAR
2024-25.
(3) A
S USED IN THIS SECTION, UNLESS THE CONTEXT OTHERWISE
REQUIRES
, "DOULA" MEANS A TRAINED BIRTH COMPANION WHO PROVIDES
PERSONAL
, NONMEDICAL SUPPORT TO PREGNANT AND POSTPARTUM PEOPLE
AND THEIR FAMILIES PRIOR TO CHILDBIRTH
, DURING LABOR AND DELIVERY,
AND DURING THE POSTPARTUM PERIOD .
SECTION 4. Appropriation. (1) For the 2023-24 state fiscal year,
$100,000 is appropriated to the department of health care policy and
financing for use by the other medical services division. This appropriation
is from the general fund. To implement this act, the division may use this
appropriation for the doula scholarship program.
(2) For the 2023-24 state fiscal year, $100,000 is appropriated to the
department of regulatory agencies for use by the division of insurance. This
appropriation is from the division of insurance cash fund created in section
10-1-103 (3), C.R.S. To implement this act, the division may use this
appropriation for personal services.
PAGE 7-SENATE BILL 23-288 SECTION 5. Safety clause. The general assembly hereby finds,
determines, and declares that this act is necessary for the immediate
preservation of the public peace, health, or safety.
____________________________ ____________________________
Steve Fenberg Julie McCluskie
PRESIDENT OF SPEAKER OF THE HOUSE
THE SENATE OF REPRESENTATIVES
____________________________ ____________________________
Cindi L. Markwell Robin Jones
SECRETARY OF CHIEF CLERK OF THE HOUSE
THE SENATE OF REPRESENTATIVES
APPROVED________________________________________
(Date and Time)
_________________________________________
Jared S. Polis
GOVERNOR OF THE STATE OF COLORADO
PAGE 8-SENATE BILL 23-288