Colorado 2023 Regular Session

Colorado Senate Bill SB288 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
	1	+	First Regular Session
	2	+	Seventy-fourth General Assembly
	3	+	STATE OF COLORADO
	4	+	REREVISED
	5	+	This Version Includes All Amendments
	6	+	Adopted in the Second House
	7	+	LLS NO. 23-0838.02 Chelsea Princell x4335
1	8		SENATE BILL 23-288
2		-	BY SENATOR(S) Fields and Buckner, Coleman, Cutter, Danielson, Exum,
3		-	Ginal, Gonzales, Hansen, Hinrichsen, Jaquez Lewis, Kolker, Marchman,
4		-	Moreno, Mullica, Priola, Roberts, Rodriguez, Sullivan, Winter F.,
5		-	Zenzinger;
6		-	also REPRESENTATIVE(S) English and Joseph, Bacon, Boesenecker,
7		-	Brown, deGruy Kennedy, Dickson, Duran, Epps, Froelich, Garcia,
8		-	Gonzales-Gutierrez, Hamrick, Herod, Jodeh, Kipp, Lindsay, Lukens,
9		-	Mabrey, Marshall, McCormick, McLachlan, Michaelson Jenet, Parenti,
10		-	Sirota, Story, Titone, Valdez, Velasco, Weissman, Willford, Woodrow,
11		-	Young, McCluskie.
	9	+	Senate Committees House Committees
	10	+	Health & Human Services Public & Behavioral Health & Human Services
	11	+	Appropriations Appropriations
	12	+	A BILL FOR AN ACT
12	13		C
13		-	ONCERNING MEASURES TO DETERMINE COVERAGE FOR DOULA SERVICES ,
14		-	AND, IN CONNECTION THEREWITH, MAKING AN APPROPRIATION.
15		-
16		-	Be it enacted by the General Assembly of the State of Colorado:
17		-	SECTION 1. Legislative declaration. (1) The general assembly
18		-	finds and declares that:
19		-	(a) There is strong evidence of positive maternal and infant
20		-	outcomes associated with doula services;
21		-	NOTE: This bill has been prepared for the signatures of the appropriate legislative
22		-	officers and the Governor. To determine whether the Governor has signed the bill
23		-	or taken other action on it, please consult the legislative status sheet, the legislative
24		-	history, or the Session Laws.
25		-	________
26		-	Capital letters or bold & italic numbers indicate new material added to existing law; dashes
27		-	through words or numbers indicate deletions from existing law and such material is not part of
28		-	the act. (b) Doula care is associated with a reduction in the number of low
29		-	birth weight babies, preterm births, cesarean sections, labor inductions, and
30		-	other medical interventions, and is associated with increased rates of
31		-	breast-feeding;
32		-	(c) Most pregnant persons who utilize doula services have positive
33		-	outcomes, and the association between doula support and positive perinatal
34		-	outcomes is even stronger for low-income people, people of color, and
35		-	people who experience cultural or language barriers to accessing pregnancy
36		-	care. However, individuals and families who could benefit the most from
37		-	doula services may have the least access to it, financially and culturally.
38		-	(d) The United States has the highest rate of maternal mortality
39		-	among developed countries, with 1,205 deaths due to maternal causes in
40		-	2021;
41		-	(e) It is estimated that more than 80 percent of the maternal
42		-	mortalities in the United States are preventable;
43		-	(f) Data from the Centers for Disease Control and Prevention shows
44		-	that nationally, Black pregnant persons are two to three times more likely
45		-	to die from pregnancy-related causes than White pregnant persons. There
46		-	are between 69 and 70 deaths per 100,000 live births for Black pregnant
47		-	persons, compared to between 26 and 27 deaths per 100,000 live births for
48		-	White pregnant persons, and 28 deaths per 100,000 live births for Hispanic
49		-	pregnant persons.
50		-	(g) High rates of maternal mortality among Black pregnant persons
51		-	span income and education levels; moreover, risk factors such as a lack of
52		-	access to prenatal care and physical health conditions do not fully explain
53		-	the racial disparity in maternal mortality;
54		-	(h) A growing body of evidence indicates that stress from racism
55		-	can result in conditions such as hypertension and preeclampsia that
56		-	contribute to poor maternal health outcomes among Black pregnant persons;
57		-	(i) In the United States, one in three births is a cesarean section,
58		-	which costs about 50 percent more than vaginal births. Studies suggest that
59		-	having a doula reduces the need for a cesarean section by 25 percent.
60		-	PAGE 2-SENATE BILL 23-288 (j) Currently, 11 states provide medicaid reimbursement for doula
61		-	services. Studies in Oregon, Minnesota, and Wisconsin have shown that
62		-	when pregnant individuals use a doula, it can save the state money.
63		-	(2) Therefore, the general assembly finds that providing doula
64		-	services for medicaid recipients in Colorado would significantly improve
65		-	health outcomes for pregnant and postpartum individuals and would help
66		-	lower the maternal mortality rate in the state.
67		-	SECTION 2. In Colorado Revised Statutes, add 25.5-4-506 as
68		-	follows:
69		-	25.5-4-506. Coverage for doula services - stakeholder process -
70		-	federal authorization - scholarship program - training - report -
71		-	definitions - repeal. (1) A
72		-	S USED IN THIS SECTION, UNLESS THE CONTEXT
73		-	OTHERWISE REQUIRES
74		-	:
	14	+	ONCERNING MEASURES TO DETERMINE COVERAGE FOR DOULA101
	15	+	SERVICES, AND, IN CONNECTION THEREWITH , MAKING AN
	16	+	102
	17	+	APPROPRIATION.103
	18	+	Bill Summary
	19	+	(Note: This summary applies to this bill as introduced and does
	20	+	not reflect any amendments that may be subsequently adopted. If this bill
	21	+	passes third reading in the house of introduction, a bill summary that
	22	+	applies to the reengrossed version of this bill will be available at
	23	+	http://leg.colorado.gov
	24	+	.)
	25	+	Not later than September 1, 2023, the bill requires the department
	26	+	of health care policy and financing (state department) to initiate a
	27	+	stakeholder process to promote the expansion and utilization of doula
	28	+	services for pregnant and postpartum medicaid recipients (recipients).
	29	+	The bill requires the state department to work with a maternity
	30	+	HOUSE
	31	+	3rd Reading Unamended
	32	+	May 6, 2023
	33	+	HOUSE
	34	+	2nd Reading Unamended
	35	+	May 3, 2023
	36	+	SENATE
	37	+	Amended 3rd Reading
	38	+	April 27, 2023
	39	+	SENATE
	40	+	Amended 2nd Reading
	41	+	April 26, 2023
	42	+	SENATE SPONSORSHIP
	43	+	Fields and Buckner, Coleman, Cutter, Danielson, Exum, Ginal, Gonzales, Hansen,
	44	+	Hinrichsen, Jaquez Lewis, Kolker, Marchman, Moreno, Mullica, Priola, Roberts, Rodriguez,
	45	+	Sullivan, Winter F., Zenzinger
	46	+	HOUSE SPONSORSHIP
	47	+	English and Joseph, Bacon, Boesenecker, Brown, deGruy Kennedy, Dickson, Duran,
	48	+	Epps, Froelich, Garcia, Gonzales-Gutierrez, Hamrick, Herod, Jodeh, Kipp, Lindsay, Lukens,
	49	+	Mabrey, Marshall, McCluskie, McCormick, McLachlan, Michaelson Jenet, Parenti, Sirota,
	50	+	Story, Titone, Valdez, Velasco, Weissman, Willford, Woodrow, Young
	51	+	Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
	52	+	Capital letters or bold & italic numbers indicate new material to be added to existing law.
	53	+	Dashes through the words or numbers indicate deletions from existing law. advisory committee to create a report detailing the findings and
	54	+	recommendations from the stakeholder process and submit the report to
	55	+	the general assembly during the state department's "SMART Act"
	56	+	hearing.
	57	+	Not later than July 1, 2024, the bill requires the state department
	58	+	to seek federal authorization for medicaid providers to provide doula
	59	+	services for pregnant and postpartum people.
	60	+	The bill creates a doula scholarship program to provide financial
	61	+	support to eligible individuals to pursue doula training and certification.
	62	+	To be eligible for a scholarship, individuals must agree to enroll as a
	63	+	doula provider and provide doula services to recipients.
	64	+	The bill requires the division of insurance (division) to contract
	65	+	with an independent entity to study the potential health-care costs and
	66	+	benefits of providing coverage for doula services in health benefit plans.
	67	+	The bill requires the division to submit a report to the general assembly
	68	+	during the state department's "SMART Act" hearing detailing the results
	69	+	and recommendations from the study during the state fiscal year 2024-25.
	70	+	Be it enacted by the General Assembly of the State of Colorado:1
	71	+	SECTION 1. Legislative declaration. (1) The general assembly2
	72	+	finds and declares that:3
	73	+	(a) There is strong evidence of positive maternal and infant4
	74	+	outcomes associated with doula services;5
	75	+	(b) Doula care is associated with a reduction in the number of low6
	76	+	birth weight babies, preterm births, cesarean sections, labor inductions,7
	77	+	and other medical interventions, and is associated with increased rates of8
	78	+	breast-feeding;9
	79	+	(c) Most pregnant persons who utilize doula services have positive10
	80	+	outcomes, and the association between doula support and positive11
	81	+	perinatal outcomes is even stronger for low-income people, people of12
	82	+	color, and people who experience cultural or language barriers to13
	83	+	accessing pregnancy care. However, individuals and families who could14
	84	+	benefit the most from doula services may have the least access to it,15
	85	+	financially and culturally.16
	86	+	288-2- (d) The United States has the highest rate of maternal mortality1
	87	+	among developed countries, with 1,205 deaths due to maternal causes in2
	88	+	2021;3
	89	+	(e) It is estimated that more than 80 percent of the maternal4
	90	+	mortalities in the United States are preventable;5
	91	+	(f) Data from the Centers for Disease Control and Prevention6
	92	+	shows that nationally, Black pregnant persons are two to three times more7
	93	+	likely to die from pregnancy-related causes than White pregnant persons.8
	94	+	There are between 69 and 70 deaths per 100,000 live births for Black9
	95	+	pregnant persons, compared to between 26 and 27 deaths per 100,000 live10
	96	+	births for White pregnant persons, and 28 deaths per 100,000 live births11
	97	+	for Hispanic pregnant persons.12
	98	+	(g) High rates of maternal mortality among Black pregnant13
	99	+	persons span income and education levels; moreover, risk factors such as14
	100	+	a lack of access to prenatal care and physical health conditions do not15
	101	+	fully explain the racial disparity in maternal mortality;16
	102	+	(h) A growing body of evidence indicates that stress from racism17
	103	+	can result in conditions such as hypertension and preeclampsia that18
	104	+	contribute to poor maternal health outcomes among Black pregnant19
	105	+	persons;20
	106	+	(i) In the United States, one in three births is a cesarean section,21
	107	+	which costs about 50 percent more than vaginal births. Studies suggest22
	108	+	that having a doula reduces the need for a cesarean section by 25 percent.23
	109	+	(j) Currently, 11 states provide medicaid reimbursement for doula24
	110	+	services. Studies in Oregon, Minnesota, and Wisconsin have shown that25
	111	+	when pregnant individuals use a doula, it can save the state money.26
	112	+	(2) Therefore, the general assembly finds that providing doula27
	113	+	288
	114	+	-3- services for medicaid recipients in Colorado would significantly improve1
	115	+	health outcomes for pregnant and postpartum individuals and would help2
	116	+	lower the maternal mortality rate in the state.3
	117	+	SECTION 2. In Colorado Revised Statutes, add 25.5-4-506 as4
	118	+	follows:5
	119	+	25.5-4-506. Coverage for doula services - stakeholder process6
	120	+	- federal authorization - scholarship program - training - report -7
	121	+	definitions - repeal. (1) AS USED IN THIS SECTION, UNLESS THE CONTEXT8
	122	+	OTHERWISE REQUIRES:9
75	123		(a) "D
76		-	OULA" MEANS A TRAINED BIRTH COMPANION WHO PROVIDES
77		-	PERSONAL
78		-	, NONMEDICAL SUPPORT TO PREGNANT AND POSTPARTUM PEOPLE
79		-	AND THEIR FAMILIES PRIOR TO CHILDBIRTH
80		-	, DURING LABOR AND DELIVERY,
81		-	AND DURING THE POSTPARTUM PERIOD .
	124	+	OULA" MEANS A TRAINED BIRTH COMPANION WHO PROVIDES10
	125	+	PERSONAL, NONMEDICAL SUPPORT TO PREGNANT AND POSTPARTUM11
	126	+	PEOPLE AND THEIR FAMILIES PRIOR TO CHILDBIRTH , DURING LABOR AND12
	127	+	DELIVERY, AND DURING THE POSTPARTUM PERIOD .13
82	128		(b) "M
83		-	ATERNITY ADVISORY COMMITTEE " MEANS THE ~~COMMITTEE~~
84		-	FACILITATED BY THE STATE DEPARTMENT COMPOSED PREDOMINANTLY OF
85		-	~~BLACK, INDIGENOUS, AND OTHER PEOPLE OF COLOR WITH MATERNITY CARE~~
86		-	~~EXPERIENCE AS RECIPIENTS~~
87		-	.
	129	+	ATERNITY ADVISORY COMMITTEE " MEANS THE COMMITTEE14
	130	+	FACILITATED BY THE STATE DEPARTMENT COMPOSED PREDOMINANTLY OF15
	131	+	B
	132	+	LACK, INDIGENOUS, AND OTHER PEOPLE OF COLOR WITH MATERNITY16
	133	+	CARE EXPERIENCE AS RECIPIENTS.17
88	134		(2) N
89		-	O LATER THAN SEPTEMBER 1, 2023, THE STATE DEPARTMENT
90		-	SHALL INITIATE A STAKEHOLDER PROCESS TO PROMOTE THE EXPANSION AND
91		-	UTILIZATION OF DOULA SERVICES FOR PREGNANT AND POSTPARTUM
92		-	RECIPIENTS IN THE STATE
93		-	. IN CONDUCTING THE STAKEHOLDER PROCESS , THE
94		-	STATE DEPARTMENT SHALL
95		-	:
	135	+	O LATER THAN SEPTEMBER 1, 2023, THE STATE DEPARTMENT18
	136	+	SHALL INITIATE A STAKEHOLDER PROCESS TO PROMOTE THE EXPANSION19
	137	+	AND UTILIZATION OF DOULA SERVICES FOR PREGNANT AND POSTPARTUM20
	138	+	RECIPIENTS IN THE STATE. IN CONDUCTING THE STAKEHOLDER PROCESS ,21
	139	+	THE STATE DEPARTMENT SHALL :22
96	140		(a) D
97		-	ESIGN AN OUTREACH STRATEGY THAT INCLUDES ~~BEST~~
98		-	PRACTICES IN COMMUNITY ENGAGEMENT
99		-	~~, INCLUDING, BUT NOT LIMITED~~ TO:
	141	+	ESIGN AN OUTREACH STRATEGY THAT INCLUDES BEST23
	142	+	PRACTICES IN COMMUNITY ENGAGEMENT , INCLUDING, BUT NOT LIMITED24
	143	+	TO:25
100	144		(I) E
101		-	NGAGING TRUSTED COMMUNITY PARTNERS TO SUPPORT THE
102		-	WORK
103		-	;
104		-	(II) R
105		-	EIMBURSEMENT OF PARTICIPATION COSTS FOR INDIVIDUALS
106		-	PAGE 3-SENATE BILL 23-288 WHO ARE NOT OTHERWISE PAID TO PARTICIPATE ;
	145	+	NGAGING TRUSTED COMMUNITY PARTNERS TO SUPPORT THE26
	146	+	WORK;27
	147	+	288
	148	+	-4- (II) REIMBURSEMENT OF PARTICIPATION COSTS FOR INDIVIDUALS1
	149	+	WHO ARE NOT OTHERWISE PAID TO PARTICIPATE ;2
107	150		(III) R
108		-	EIMBURSEMENT OF CHILD CARE COSTS FOR INDIVIDUALS WHO
109		-	PARTICIPATE
110		-	; AND
111		-	(IV) TRANSLATION SERVICES AND MEETING TIMES THAT ALLOW
112		-	DIVERSE AND INCLUSIVE PARTICIPATION
113		-	;
	151	+	EIMBURSEMENT OF CHILD CARE COSTS FOR INDIVIDUALS3
	152	+	WHO PARTICIPATE; AND4
	153	+	(IV) T
	154	+	RANSLATION SERVICES AND MEETING TIMES THAT ALLOW5
	155	+	DIVERSE AND INCLUSIVE PARTICIPATION;6
114	156		(b) S
115		-	OLICIT FEEDBACK RELATED TO:
	157	+	OLICIT FEEDBACK RELATED TO:7
116	158		(I) A
117	159		N APPROVED DOULA CERTIFICATION PROCESS THAT
118		-	~~INCORPORATES NATIONAL AND LOCAL TRAINING PROGRAMS~~
119		-	;
	160	+	8
	161	+	INCORPORATES NATIONAL AND LOCAL TRAINING PROGRAMS ;9
120	162		(II) A
121		-	BILLING PROCESS FOR DOULA SERVICES;
	163	+	BILLING PROCESS FOR DOULA SERVICES; 10
122	164		(III) W
123		-	AYS TO RECRUIT DOULAS AND INTEGRATE THEM INTO
124		-	HOSPITAL DELIVERIES
125		-	;
	165	+	AYS TO RECRUIT DOULAS AND INTEGRATE THEM INTO11
	166	+	HOSPITAL DELIVERIES;12
126	167		(IV) S
127		-	UPPORT NEEDED TO BUILD AND RETAIN A DOULA WORKFORCE ;
	168	+	UPPORT NEEDED TO BUILD AND RETAIN A DOULA13
	169	+	WORKFORCE;14
128	170		(V) C
129		-	OMMUNITY OUTREACH TO DETERMINE HOW TO BEST PROMOTE
130		-	DOULA SERVICES
131		-	; AND
132		-	(VI) THE DOULA SCHOLARSHIP PROGRAM CREATED IN SUBSECTION
133		-	(7) OF THIS SECTION.
	171	+	OMMUNITY OUTREACH TO DETERMINE HOW TO BEST15
	172	+	PROMOTE DOULA SERVICES; AND16
	173	+	(VI) T
	174	+	HE DOULA SCHOLARSHIP PROGRAM CREATED IN SUBSECTION17
	175	+	(7)
	176	+	OF THIS SECTION.18
134	177		(3) S
135		-	TAKEHOLDERS MUST BE DIVERSE WITH REGARD TO RACE ,
136		-	ETHNICITY, IMMIGRATION STATUS, SEXUAL ORIENTATION, AND GENDER, AND
137		-	MUST REPRESENT OTHER POPULATIONS THAT EXPERIENCE GREATER HEALTH
138		-	DISPARITIES AND INEQUITIES
139		-	. THE STATE DEPARTMENT MAY INCLUDE THE
140		-	FOLLOWING IN THE STAKEHOLDER PROCESS
141		-	:
	178	+	TAKEHOLDERS MUST BE DIVERSE WITH REGARD TO RACE ,19
	179	+	ETHNICITY, IMMIGRATION STATUS, SEXUAL ORIENTATION, AND GENDER,20
	180	+	AND MUST REPRESENT OTHER POPULATIONS THAT EXPERIENCE GREATER21
	181	+	HEALTH DISPARITIES AND INEQUITIES . THE STATE DEPARTMENT MAY22
	182	+	INCLUDE THE FOLLOWING IN THE STAKEHOLDER PROCESS :23
142	183		(a) D
143		-	OULAS AND POTENTIAL DOULAS WHO MAY SERVE RECIPIENTS
144		-	WHO INCLUDE
145		-	, BUT ARE NOT LIMITED TO, BLACK, INDIGENOUS, AND OTHER
146		-	PEOPLE OF COLOR
147		-	, REFUGEES, NON-ENGLISH SPEAKERS, PEOPLE LIVING IN
148		-	RURAL AREAS
149		-	, AND PEOPLE WHO WERE RECENTLY INCARCERATED ;
150		-	(b) I
151		-	NDIVIDUALS INDIRECTLY INVOLVED IN THE DELIVERY OF DOULA
152		-	SERVICES
153		-	, INCLUDING, BUT NOT LIMITED TO , CLINICAL PROVIDERS,
154		-	HOSPITALS, MANAGED CARE ENTITIES, AND STATE PARTNERS, INCLUDING,
155		-	PAGE 4-SENATE BILL 23-288 BUT NOT LIMITED TO , THE DEPARTMENT OF PUBLIC HEALTH AND
156		-	ENVIRONMENT
157		-	, DEPARTMENT OF HUMAN SERVICES , DEPARTMENT OF EARLY
158		-	CHILDHOOD
159		-	, AND DEPARTMENT OF REGULATORY AGENCIES ;
	184	+	OULAS AND POTENTIAL DOULAS WHO MAY SERVE RECIPIENTS24
	185	+	WHO INCLUDE, BUT ARE NOT LIMITED TO, BLACK, INDIGENOUS, AND OTHER25
	186	+	PEOPLE OF COLOR, REFUGEES, NON-ENGLISH SPEAKERS, PEOPLE LIVING IN26
	187	+	RURAL AREAS, AND PEOPLE WHO WERE RECENTLY INCARCERATED ;27
	188	+	288
	189	+	-5- (b) INDIVIDUALS INDIRECTLY INVOLVED IN THE DELIVERY OF1
	190	+	DOULA SERVICES, INCLUDING, BUT NOT LIMITED TO, CLINICAL PROVIDERS,2
	191	+	HOSPITALS, MANAGED CARE ENTITIES, AND STATE PARTNERS, INCLUDING,3
	192	+	BUT NOT LIMITED TO , THE DEPARTMENT OF PUBLIC HEALTH AND4
	193	+	ENVIRONMENT, DEPARTMENT OF HUMAN SERVICES , DEPARTMENT OF5
	194	+	EARLY CHILDHOOD, AND DEPARTMENT OF REGULATORY AGENCIES ;6
160	195		(c) R
161		-	EPRESENTATIVES FROM THE DIVISION OF INSURANCE WITH
162		-	SUBJECT MATTER EXPERTISE
163		-	; AND
164		-	(d) REPRESENTATIVES FROM THE MATERNITY ADVISORY COMMITTEE ;
	196	+	EPRESENTATIVES FROM THE DIVISION OF INSURANCE WITH7
	197	+	SUBJECT MATTER EXPERTISE; AND8
	198	+	(d) R
	199	+	EPRESENTATIVES FROM THE MATERNITY ADVISORY9
	200	+	COMMITTEE;
	201	+	10
165	202		(e) C
166	203		ONSUMER ADVOCATES ; AND
167		-	(f) EXPERTS ON PERINATAL CARE AND QUALITY .
	204	+	11
	205	+	(f) E
	206	+	XPERTS ON PERINATAL CARE AND QUALITY .
	207	+	12
168	208		(4) F
169		-	OR STATE FISCAL YEAR 2024-25, THE STATE DEPARTMENT
170		-	SHALL SUBMIT A REPORT TO THE GENERAL ASSEMBLY AS PART OF THE STATE
171		-	DEPARTMENT
172		-	'S "SMART ACT" PRESENTATION REQUIRED BY SECTION
173		-	2-7-203. THE REPORT MUST INCLUDE FINDINGS AND RECOMMENDATIONS
174		-	FROM THE STAKEHOLDER PROCESS AS DESCRIBED IN SUBSECTION
175		-	(2) OF THIS
176		-	SECTION
177		-	. THE STATE DEPARTMENT SHALL WORK WITH THE MATERNITY
178		-	ADVISORY COMMITTEE TO CREATE THE REPORT
179		-	.
	209	+	OR STATE FISCAL YEAR 2024-25, THE STATE DEPARTMENT13
	210	+	SHALL SUBMIT A REPORT TO THE GENERAL ASSEMBLY AS PART OF THE14
	211	+	STATE DEPARTMENT'S "SMART ACT" PRESENTATION REQUIRED BY15
	212	+	SECTION 2-7-203. THE REPORT MUST INCLUDE FINDINGS AND16
	213	+	RECOMMENDATIONS FROM THE STAKEHOLDER PROCESS AS DESCRIBED IN17
	214	+	SUBSECTION (2) OF THIS SECTION. THE STATE DEPARTMENT SHALL WORK18
	215	+	WITH THE MATERNITY ADVISORY COMMITTEE TO CREATE THE REPORT .19
180	216		(5) I
181		-	N CARRYING OUT THE STAKEHOLDER PROCESS DESCRIBED IN
182		-	SUBSECTION
183		-	(2) OF THIS SECTION, THE STATE DEPARTMENT IS EXEMPT FROM
184		-	THE
185		-	"PROCUREMENT CODE", ARTICLES 101 TO 112 OF TITLE 24.
	217	+	N CARRYING OUT THE STAKEHOLDER PROCESS DESCRIBED IN20
	218	+	SUBSECTION (2) OF THIS SECTION, THE STATE DEPARTMENT IS EXEMPT21
	219	+	FROM THE "PROCUREMENT CODE", ARTICLES 101 TO 112 OF TITLE 24.22
186	220		(6) N
187		-	OT LATER THAN JULY 1, 2024, THE STATE DEPARTMENT SHALL
188		-	SEEK FEDERAL AUTHORIZATION TO PROVIDE DOULA SERVICES FOR PREGNANT
189		-	AND POSTPARTUM PEOPLE TO IMPROVE HEALTH OUTCOMES OF PREGNANT
190		-	AND POSTPARTUM PEOPLE WHO FACE A DISPROPORTI ONATELY GREATER RISK
191		-	OF POOR BIRTH OUTCOMES
192		-	.
193		-	(7) (a) N
194		-	OT LATER THAN JULY 1, 2024, THE STATE DEPARTMENT
195		-	SHALL CREATE A DOULA SCHOLARSHIP PROGRAM THAT GRANTS FUNDS TO
196		-	INDIVIDUALS WITHOUT SUFFICIENT FINANCIAL RESOURCES TO COMPLETE
197		-	DOULA TRAINING AND CERTIFICATION PROGRAMS NECESSARY TO PROVIDE
198		-	DOULA SERVICES
199		-	.
	221	+	OT LATER THAN JULY 1, 2024, THE STATE DEPARTMENT23
	222	+	SHALL SEEK FEDERAL AUTHORIZATION TO PROVIDE DOULA SERVICES FOR24
	223	+	PREGNANT AND POSTPARTUM PEOPLE TO IMPROVE HEALTH OUTCOMES OF25
	224	+	PREGNANT AND POSTPARTUM PEOPLE WHO FACE A DISPROPORTIONATELY26
	225	+	GREATER RISK OF POOR BIRTH OUTCOMES .27
	226	+	288
	227	+	-6- (7) (a) NOT LATER THAN JULY 1, 2024, THE STATE DEPARTMENT1
	228	+	SHALL CREATE A DOULA SCHOLARSHIP PROGRAM THAT GRANTS FUNDS TO2
	229	+	INDIVIDUALS WITHOUT SUFFICIENT FINANCIAL RESOURCES TO COMPLETE3
	230	+	DOULA TRAINING AND CERTIFICATION PROGRAMS NECESSARY TO PROVIDE4
	231	+	DOULA SERVICES.5
200	232		(b) I
201		-	N DESIGNING THE DOULA SCHOLARSHIP PROGRAM , THE ~~STATE~~
202		-	DEPARTMENT SHALL SOLICIT INPUT FROM GROUPS IDENTIFIED ~~IN SUBSECTION~~
203		-	(3) OF THIS SECTION.
204		-	~~PAGE 5-SENATE BILL 23-288~~ (c) ~~THE STATE DEPARTMENT SHALL DEFINE ELIGIBILITY CRITERIA FOR~~
205		-	~~THE DOULA SCHOLARSHIP PROGRAM THAT INCLUDES~~
206		-	, BUT IS ~~NOT LIMITED TO,~~
207		-	THE FOLLOWING:
	233	+	N DESIGNING THE DOULA SCHOLARSHIP PROGRAM , THE STATE6
	234	+	DEPARTMENT SHALL SOLICIT INPUT FROM GROUPS IDENTIFIED IN7
	235	+	SUBSECTION (3) OF THIS SECTION.8
	236	+	(c) T
	237	+	HE STATE DEPARTMENT SHALL DEFINE ELIGIBILITY CRITERIA9
	238	+	FOR THE DOULA SCHOLARSHIP PROGRAM THAT INCLUDES , BUT IS NOT10
	239	+	LIMITED TO, THE FOLLOWING:11
208	240		(I) P
209		-	ROOF OF FINANCIAL HARDSHIP;
	241	+	ROOF OF FINANCIAL HARDSHIP;12
210	242		(II) P
211		-	ROOF OF STATE RESIDENCY; AND
212		-	(III) A STATEMENT OF INTENT TO SERVE AS A DOULA PROVIDER IN
213		-	COLORADO FOR PREGNANT AND POSTPARTUM RECIPIENTS .
	243	+	ROOF OF STATE RESIDENCY; AND13
	244	+	(III) A
	245	+	STATEMENT OF INTENT TO SERVE AS A DOULA PROVIDER IN14
	246	+	C
	247	+	OLORADO FOR PREGNANT AND POSTPARTUM RECIPIENTS .15
214	248		(d) T
215		-	HE STATE DEPARTMENT SHALL DEFINE CRITERIA FOR
216		-	ORGANIZATIONS TO CONDUCT TRAINING AND CERTIFICATION PROGRAMS FOR
217		-	DOULAS THAT INCLUDE
218		-	, BUT ARE NOT LIMITED TO:
	249	+	HE STATE DEPARTMENT SHALL DEFINE CRITERIA FOR16
	250	+	ORGANIZATIONS TO CONDUCT TRAINING AND CERTIFICATION PROGRAMS17
	251	+	FOR DOULAS THAT INCLUDE, BUT ARE NOT LIMITED TO:18
219	252		(I) A
220		-	N APPROVED CERTIFICATION PROCESS FOR DOULAS ;
	253	+	N APPROVED CERTIFICATION PROCESS FOR DOULAS ;19
221	254		(II) A
222		-	N EQUITABLE APPROACH TO DOULA RECRUITMENT AND
223		-	TRAINING
224		-	; AND
225		-	(III) AN APPROVED BUDGET TO PROVIDE FREE TRAINING TO
226		-	ATTENDEES
227		-	.
	255	+	N EQUITABLE APPROACH TO DOULA RECRUITMENT AND20
	256	+	TRAINING; AND21
	257	+	(III) A
	258	+	N APPROVED BUDGET TO PROVIDE FREE TRAINING TO22
	259	+	ATTENDEES.23
228	260		(e) T
229		-	HE STATE DEPARTMENT MAY REQUIRE INDIVIDUALS WHO
230		-	RECEIVE SCHOLARSHIP MONEY PURSUANT TO THE DOULA SCHOLARSHIP
231		-	PROGRAM DESCRIBED IN THIS SUBSECTION
232		-	(7) TO SUBMIT TO THE STATE
233		-	DEPARTMENT
234		-	, NOT LATER THAN SIX MONTHS AFTER THE INDIVIDUAL 'S
235		-	COMPLETION OF DOULA TRAINING OR CERTIFICATION
236		-	, DOCUMENTATION
237		-	THAT THE INDIVIDUAL IS SERVING AS A DOULA FOR RECIPIENTS OR IS
238		-	WORKING TOWARD ENROLLMENT AS A DOULA FOR RECIPIENTS
239		-	. IF AN
240		-	INDIVIDUAL DOES NOT COMPLETE THE DOCUMENTATION
241		-	, THE STATE
242		-	DEPARTMENT MAY SEEK REPAYMENT OF THE FUNDS AWARDED TO THE
243		-	INDIVIDUAL THROUGH THE DOULA SCHOLARSHIP PROGRAM
244		-	.
245		-	(f) (I) A
246		-	NY MONEY APPROPRIATED TO THE DOULA SCHOLARSHIP
247		-	PROGRAM AND NOT EXPENDED PRIOR TO
248		-	JULY 1, 2024, IS FURTHER
249		-	APPROPRIATED TO THE STATE DEPARTMENT THROUGH
250		-	JUNE 30, 2025, TO BE
251		-	USED FOR THE SAME PURPOSE
252		-	.
	261	+	HE STATE DEPARTMENT MAY REQUIRE INDIVIDUALS WHO24
	262	+	RECEIVE SCHOLARSHIP MONEY PURSUANT TO THE DOULA SCHOLARSHIP25
	263	+	PROGRAM DESCRIBED IN THIS SUBSECTION (7) TO SUBMIT TO THE STATE26
	264	+	DEPARTMENT, NOT LATER THAN SIX MONTHS AFTER THE INDIVIDUAL 'S27
	265	+	288
	266	+	-7- COMPLETION OF DOULA TRAINING OR CERTIFICATION , DOCUMENTATION1
	267	+	THAT THE INDIVIDUAL IS SERVING AS A DOULA FOR RECIPIENTS OR IS2
	268	+	WORKING TOWARD ENROLLMENT AS A DOULA FOR RECIPIENTS . IF AN3
	269	+	INDIVIDUAL DOES NOT COMPLETE THE DOCUMENTATION , THE STATE4
	270	+	DEPARTMENT MAY SEEK REPAYMENT OF THE FUNDS AWARDED TO THE5
	271	+	INDIVIDUAL THROUGH THE DOULA SCHOLARSHIP PROGRAM .6
	272	+	(f) (I) ANY MONEY APPROPRIATED TO THE DOULA SCHOLARSHIP7
	273	+	PROGRAM AND NOT EXPENDED PRIOR TO JULY 1, 2024, IS FURTHER8
	274	+	APPROPRIATED TO THE STATE DEPARTMENT THROUGH JUNE 30, 2025, TO9
	275	+	BE USED FOR THE SAME PURPOSE.10
253	276		(II) T
254	277		HIS SUBSECTION (7)(f) IS REPEALED, EFFECTIVE JULY 1, 2026.
255		-	~~PAGE 6-SENATE BILL 23-288 (g) NOTWITHSTANDING SECTION 24-1-136 (~~11~~)(a)(I), THE STATE~~
256		-	~~DEPARTMENT SHALL REPORT ANNUALLY BEGINNING IN~~
257		-	~~2025 TO~~ THE
258		-	~~GENERAL ASSEMBLY AS PART OF THE STATE DEPARTMENT~~
259		-	'S "~~SMART ACT"~~
260		-	~~PRESENTATION, AS REQUIRED BY SECTION 2-7-203, ON THE UTILIZATION AND~~
261		-	~~OUTCOMES OF THE DOULA SCHOLARSHIP PROGRAM~~
262		-	.
263		-	SECTION 3. In Colorado Revised Statutes, add 10-16-155.5 as
264		-	follows:
265		-	10-16-155.5. Actuarial review of doula services - report -
	278	+	11
	279	+	(g) N
	280	+	OTWITHSTANDING SECTION 24-1-136 (11)(a)(I), THE STATE12
	281	+	DEPARTMENT SHALL REPORT ANNUALLY BEGINNING IN 2025 TO THE13
	282	+	GENERAL ASSEMBLY AS PART OF THE STATE DEPARTMENT 'S "SMART14
	283	+	A
	284	+	CT" PRESENTATION, AS REQUIRED BY SECTION 2-7-203, ON THE15
	285	+	UTILIZATION AND OUTCOMES OF THE DOULA SCHOLARSHIP PROGRAM .16
	286	+	SECTION 3. In Colorado Revised Statutes, add 10-16-155.5 as17
	287	+	follows:18
	288	+	10-16-155.5. Actuarial review of doula services - report -19
266	289		definition. (1) T
267		-	HE DIVISION SHALL CONTRACT WITH AN INDEPENDENT
268		-	ENTITY TO CONDUCT AN ACTUARIAL REVIEW OF THE POTENTIAL
269		-	HEALTH
270		-	-CARE COSTS AND BENEFITS OF INCLUDING COVERAGE FOR DOULA
271		-	SERVICES FOR PREGNANT AND POSTPARTUM PERSONS COVERED BY HEALTH
272		-	BENEFIT PLANS
273		-	.
	290	+	HE DIVISION SHALL CONTRACT WITH AN INDEPENDENT20
	291	+	ENTITY TO CONDUCT AN ACTUARIAL REVIEW OF THE POTENTIAL21
	292	+	HEALTH-CARE COSTS AND BENEFITS OF INCLUDING COVERAGE FOR DOULA22
	293	+	SERVICES FOR PREGNANT AND POSTPARTUM PERSONS COVERED BY HEALTH23
	294	+	BENEFIT PLANS.24
274	295		(2) T
275		-	HE DIVISION SHALL PRESENT THE RESULTS FROM THE
276		-	ACTUARIAL REVIEW CONDUCTED PURSUANT TO SUBSECTION
277		-	(1) OF THIS
278		-	SECTION TO THE GENERAL ASSEMBLY AS PART OF THE DIVISION
279		-	'S "SMART
280		-	A
281		-	CT" PRESENTATION REQUIRED BY SECTION 2-7-203 DURING STATE FISCAL
282		-	YEAR
283		-	2024-25.
	296	+	HE DIVISION SHALL PRESENT THE RESULTS FROM THE25
	297	+	ACTUARIAL REVIEW CONDUCTED PURSUANT TO SUBSECTION (1) OF THIS26
	298	+	SECTION TO THE GENERAL ASSEMBLY AS PART OF THE DIVISION 'S "SMART27
	299	+	288
	300	+	-8- ACT" PRESENTATION REQUIRED BY SECTION 2-7-203 DURING STATE FISCAL1
	301	+	YEAR 2024-25.2
284	302		(3) A
285		-	S USED IN THIS SECTION, UNLESS THE CONTEXT OTHERWISE
286		-	REQUIRES
287		-	, "DOULA" MEANS A TRAINED BIRTH COMPANION WHO PROVIDES
288		-	PERSONAL
289		-	, NONMEDICAL SUPPORT TO PREGNANT AND POSTPARTUM PEOPLE
290		-	AND THEIR FAMILIES PRIOR TO CHILDBIRTH
291		-	, DURING LABOR AND DELIVERY,
292		-	AND DURING THE POSTPARTUM PERIOD .
293		-	SECTION 4. Appropriation. (1) For the 2023-24 state fiscal year,
294		-	$100,000 is appropriated to the department of health care policy and
295		-	financing for use by the other medical services division. This appropriation
296		-	is from the general fund. To implement this act, the division may use this
297		-	appropriation for the doula scholarship program.
298		-	(2) For the 2023-24 state fiscal year, $100,000 is appropriated to the
299		-	department of regulatory agencies for use by the division of insurance. This
300		-	appropriation is from the division of insurance cash fund created in section
301		-	10-1-103 (3), C.R.S. To implement this act, the division may use this
302		-	appropriation for personal services.
303		-	PAGE 7-SENATE BILL 23-288 SECTION 5. Safety clause. The general assembly hereby finds,
304		-	determines, and declares that this act is necessary for the immediate
305		-	preservation of the public peace, health, or safety.
306		-	____________________________ ____________________________
307		-	Steve Fenberg Julie McCluskie
308		-	PRESIDENT OF SPEAKER OF THE HOUSE
309		-	THE SENATE OF REPRESENTATIVES
310		-	____________________________ ____________________________
311		-	Cindi L. Markwell Robin Jones
312		-	SECRETARY OF CHIEF CLERK OF THE HOUSE
313		-	THE SENATE OF REPRESENTATIVES
314		-	APPROVED________________________________________
315		-	(Date and Time)
316		-	_________________________________________
317		-	Jared S. Polis
318		-	GOVERNOR OF THE STATE OF COLORADO
319		-	PAGE 8-SENATE BILL 23-288
	303	+	S USED IN THIS SECTION, UNLESS THE CONTEXT OTHERWISE3
	304	+	REQUIRES, "DOULA" MEANS A TRAINED BIRTH COMPANION WHO PROVIDES4
	305	+	PERSONAL, NONMEDICAL SUPPORT TO PREGNANT AND POSTPARTUM5
	306	+	PEOPLE AND THEIR FAMILIES PRIOR TO CHILDBIRTH , DURING LABOR AND6
	307	+	DELIVERY, AND DURING THE POSTPARTUM PERIOD .7
	308	+	SECTION 4. Appropriation. (1) For the 2023-24 state fiscal
	309	+	8
	310	+	year, $100,000 is appropriated to the department of health care policy and9
	311	+	financing for use by the other medical services division. This10
	312	+	appropriation is from the general fund. To implement this act, the division11
	313	+	may use this appropriation for the doula scholarship program.12
	314	+	(2) For the 2023-24 state fiscal year, $100,000 is appropriated to13
	315	+	the department of regulatory agencies for use by the division of insurance.14
	316	+	This appropriation is from the division of insurance cash fund created in15
	317	+	section 10-1-103 (3), C.R.S. To implement this act, the division may use16
	318	+	this appropriation for personal services.17
	319	+	SECTION 5. Safety clause. The general assembly hereby finds,18
	320	+	determines, and declares that this act is necessary for the immediate19
	321	+	preservation of the public peace, health, or safety.20
	322	+	288
	323	+	-9-