Second Regular Session
Seventy-fourth General Assembly
STATE OF COLORADO
REVISED
This Version Includes All Amendments Adopted
on Second Reading in the Second House
LLS NO. 24-0285.01 Yelana Love x2295
HOUSE BILL 24-1262
House Committees Senate Committees
Health & Human Services Health & Human Services
Appropriations Appropriations
A BILL FOR AN ACT
C
ONCERNING MATERNAL
HEALTH, AND, IN CONNECTION THEREWITH,101
MAKING AN APPROPRIATION .102
Bill Summary
(Note: This summary applies to this bill as introduced and does
not reflect any amendments that may be subsequently adopted. If this bill
passes third reading in the house of introduction, a bill summary that
applies to the reengrossed version of this bill will be available at
http://leg.colorado.gov
.)
Current law requires "direct-entry midwives" to register with the
division of professions and occupations in the department of regulatory
agencies before practicing. Sections 2 through 12 of the bill make
changes within the direct-entry midwives practice act to update the title
of these professionals to "certified professional midwives" and change the
regulation from registration to licensure. Sections 21 through 31 make
SENATE
Amended 2nd Reading
May 3, 2024
HOUSE
3rd Reading Unamended
April 17, 2024
HOUSE
Amended 2nd Reading
April 16, 2024
HOUSE SPONSORSHIP
Garcia and Jodeh, Bacon, Boesenecker, Brown, Duran, Epps, Froelich, Hamrick, Herod,
Kipp, Lieder, Lindstedt, Mabrey, Marvin, McCormick, McLachlan, Ortiz, Parenti, Rutinel,
Sirota, Story, Titone, Velasco, Willford, Young
SENATE SPONSORSHIP
Buckner and Michaelson Jenet,
Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
Capital letters or bold & italic numbers indicate new material to be added to existing law.
Dashes through the words or numbers indicate deletions from existing law. the same updates to current law in other statutes outside of the practice
act.
Current law allows the state board for community colleges and
occupational education to use unexpended resources from the in-demand
short-term health-care credentials program (program) to expand the
eligible programs that may receive support through the program. Section
13 allows the board to expand the eligible programs to include certified
professional midwives.
Section 14 requires the civil rights commission to establish certain
parameters when receiving reports for maternity care. Section 15 adds
pregnancy as a protected class for purposes of discrimination in places of
public accommodation.
The bill adds a midwife to the environmental justice advisory
board (section 16) and the governor's expert emergency epidemic
response committee (section 20).
Section 17 requires a health facility that provides maternal health
services to notify certain individuals before eliminating or reducing the
services.
Section 18 adds midwifery as a preferred area of expertise for
members of the health equity commission.
Section 19 requires the maternal mortality review committee to:
! Study closures related to perinatal health-care practices and
facilities and perinatal health-care deserts and assets related
to perinatal health and health-care services across the state,
not limited to obstetric providers;
! Identify major outcome categories that the department of
public health and environment should track over time and
identify risks and opportunities;
! Explore the effects of practice and facility closures
(closures) on maternal and infant health outcomes and
experiences;
! Identify recommendations during closures and resultant
transfers of care;
! Identify best practice guidelines during closures and
resultant transfers of care; and
! Create a maternal health desert and asset map.
Be it enacted by the General Assembly of the State of Colorado:1
SECTION 1. Legislative declaration. (1) The general assembly2
finds and declares that:3
(a) With the increased demand for reproductive health-care4
1262-2- services in the state, it is important to support the full infrastructure of1
reproductive health-care providers. This includes:2
(I) Integrating the services and expertise of direct-entry midwives;3
(II) Assessing and maintaining the level of reproductive4
health-care services needed in a community in a way that is accessible to5
the community;6
(III) Understanding the assets and the gaps in services at the7
county level; and8
(IV) Understanding and implementing best practices for when9
services are discontinued in a community, including providing notice10
and a transition plan to the state in order to recognize and monitor the11
ongoing impact to the community.12
(b) Demand for community birth options jumped 30% from 201913
to 2020, with the majority of demand coming from Black and Latinx14
birthing people;15
(c) People are choosing community birth care because they find16
it supportive of not just their health needs but their social, spiritual, and17
community values and needs; however, community birth facilities and18
providers face barriers to providing care; 19
20
(d) Patients should have the ability to choose the provider that is21
right for them, regardless of the setting. Especially for underserved Black,22
Indigenous, Asian, rural, refugee, or immigrant communities or someone23
dealing with a substance use or mental health condition, the ability to24
choose a provider that can meet their needs isn't just important, it could25
be lifesaving.26
(e) Facility and practice closures leave communities scrambling27
1262
-3- when they close suddenly and without guidance to patients. When1
closures occur, the state must ensure that vulnerable communities are2
protected.3
(f) The preventable maternal mortality crisis is only growing4
worse in our state, disproportionately harming Black and Indigenous5
people; and6
(g) The maternal mortality review committee has made several7
recommendations to combat this crisis, including:8
(I) Increased access to a variety of health-care professionals, such9
as direct-entry midwives;10
(II) Addressing critical maternal health workforce shortages, such11
as ensuring that direct-entry midwives can provide care at their full scope12
and preventing perinatal facility and practice closures as much as13
possible;14
(III) Examining unintended consequences of policies and15
procedures, such as exploring the impact of facility and practice closures16
on Black, Indigenous, Latinx, Asian, rural, and immigrant and refugee17
communities; and18
(IV) The Colorado department of public health and environment19
recommends that health-care providers be trained and prepared to provide20
a type of care that direct-entry midwives already specialize in. The21
midwifery model of care exemplifies certain recommendations such as22
dyad care, trauma-informed care, shared decision-making, and expertise23
in safe transitions, care navigation, and wraparound services.24
25
SECTION 2. In Colorado Revised Statutes, amend 12-225-11426
as follows:27
1262
-4- 12-225-114. Repeal of article - subject to review. This article1
225 is repealed, effective September 1, 2028. Before the repeal, the2
registering of direct-entry midwives by the division is scheduled for3
review in accordance with section 24-34-104.4
5
SECTION 3. In Colorado Revised Statutes, 24-34-305, amend6
(1)(k) as follows:7
24-34-305. Powers and duties of commission. (1) The8
commission has the following powers and duties:9
(k) (I) To receive reports from people alleging
MISTREATMENT IN10
THE CONTEXT OF maternity care, INCLUDING CARE that is not organized11
for, and provided to, a person who is pregnant or in the postpartum period12
AS DEFINED IN SECTION 12-225-103, in a manner that is culturally13
congruent; maintains
THAT FAILS TO MAINTAIN the person's dignity,14
privacy, and confidentiality; ensures THAT FAILS TO ENSURE freedom from15
harm and mistreatment; and enables THAT FAILS TO ENABLE informed16
choices and continuous support.17
(II) R
EPORTS SHALL BE COLLECTED IN A WAY TO ENSURE THAT :18
(A) C
ONFIDENTIAL INFORMATION CAN BE DE -IDENTIFIED;19
(B) I
NDIVIDUALS CAN IDENTIFY MISTREATMENT THEY20
EXPERIENCED BASED ON THE FOLLOWING MISTREATMENT INDEX21
CATEGORIES: PHYSICAL ABUSE, SEXUAL ABUSE, VERBAL ABUSE, STIGMA22
AND DISCRIMINATION, FAILURE TO MEET PROFESSIONAL STANDARDS OF23
CARE, OR POOR RAPPORT BETWEEN PATIENTS OR CLIENTS AND PROVIDERS ;24
POOR CONDITIONS AND CONSTRAINTS PRESENTED BY THE HEALTH -CARE25
SYSTEM; AND OBSTETRIC RACISM;26
(C) N
UMBERS OF REPORTS BASED ON
TYPOLOGY CAN BE27
1262
-5- GENERATED AND SHARED WITH THE PUBLIC AND OTHER AGENCIES ;1
(D) A
N INDIVIDUAL MAY IDENTIFY ANY PROTECTED CLASS THE2
INDIVIDUAL MAY BE PART OF AND THAT MAY HAVE FACTORED INTO THE3
INDIVIDUAL'S MISTREATMENT;4
(E) A
N INDIVIDUAL MAY INDICATE WHAT MIGHT HAVE BEEN DONE5
DIFFERENTLY TO IMPROVE THE INDIVIDUAL 'S SITUATION;6
(F) A
N INDIVIDUAL MAY ENTER NARRATIVE INFORMATION IN THE7
INDIVIDUAL'S OWN WORDS; AND8
(G) A
N INDIVIDUAL MAY VOLUNTARILY SHARE THE INDIVIDUAL 'S9
CONTACT INFORMATION AND INDICATE WHETHER THE INDIVIDUAL10
CONSENTS TO BEING CONTACTED BY THE DEPARTMENT OF REGULATORY11
AGENCIES OR THE DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT . 12
(III) T
HE COMMISSION SHALL GENERATE DE -IDENTIFIED13
COMPOSITE INFORMATION BASED ON REPORTS SUBMITTED PURSUANT TO14
THIS SUBSECTION (1)(k). NOTWITHSTANDING SECTION 24-1-136 (11)(a)(I),15
NO LATER THAN JULY 1, 2025, AND NO LATER THAN JULY 1 EVERY THREE16
YEARS THEREAFTER, THE COMMISSION SHALL SHARE THE GENERATED17
DE-IDENTIFIED COMPOSITE INFORMATION WITH :18
(A) T
HE COLORADO MATERNAL MORTALITY REVIEW COMMITTEE19
CREATED IN SECTION 25-52-104 (1);20
(B) T
HE HOUSE OF REPRESENTATIVES HEALTH AND HUMAN21
SERVICES COMMITTEE AND THE SENATE HEALTH AND HUMAN SERVICES22
COMMITTEE, OR THEIR SUCCESSOR COMMITTEES ; AND23
(C) T
HE MATERNITY ADVISORY COMMITTEE DEFINED IN SECTION24
25.5-4-506 (1)(b).25
(IV) R
EPORTS MAY BE SHARED INTERNALLY WITH STAFF FOR26
STUDY, INVESTIGATION, REPORTS, PUBLICATIONS, OR HEARINGS.27
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SECTION 4. In Colorado Revised Statutes, 25-1-134, amend2
(2)(c)(IV) as follows:3
25-1-134. Environmental justice - ombudsperson - advisory4
board - grant program - definitions - repeal. (2) Environmental5
justice advisory board. (c) The advisory board consists of the following6
twelve members who, to the extent practicable, must reside in different7
geographic areas of the state, reflect the racial and ethnic diversity of the8
state, and have experience with a range of environmental issues, including9
air pollution, water contamination, and public health impacts:10
(IV) Four voting members appointed by the executive director of11
the department,
AT LEAST ONE OF WHOM MUST BE A MIDWIFE WHO IS12
PRACTICING IN A FREESTANDING BIRTH CENTER , IN A RURAL AREA, OR AS13
A HOME BIRTH PROVIDER.14
SECTION 5.
In Colorado Revised Statutes, add 25-3-131 as15
follows:16
25-3-131. Maternal health-care services - discontinuation17
- required notifications - definition - repeal. (1) EXCEPT AS PROVIDED18
IN SUBSECTION (3) OF THIS SECTION, AT LEAST NINETY DAYS BEFORE A19
HOSPITAL PROVIDING MATERNAL HEALTH-CARE SERVICES OR A BIRTH20
CENTER MAY DISCONTINUE SUCH SERVICES, THE FACILITY SHALL PROVIDE21
NOTICE TO:22
(a) T
HE
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT23
RESPONSIBLE FOR LICENSING HEALTH FACILITIES PURSUANT TO SECTION24
25-3-101;25
(b) THE PRIMARY CARE OFFICE, CREATED IN SECTION 25-1.5-403;26
(c) T
HE GOVERNOR;27
1262
-7- (d) ALL PATIENTS RECEIVING MATERNAL HEALTH -CARE SERVICES1
AT THE FACILITY AS OF THE DATE OF THE NOTICE;2
(e) A
LL HEALTH-CARE PROVIDERS THAT PROVIDE MATERNAL3
HEALTH-CARE SERVICES FOR THE FACILITY AS OF THE DATE OF THE4
NOTICE; AND5
(f) T
HE GENERAL PUBLIC.6
(2) T
HE NOTICE REQUIRED IN SUBSECTION (1) OF THIS SECTION7
MUST INCLUDE:8
(a) A
DESCRIPTION OF THE MATERNAL HEALTH -CARE SERVICES9
BEING
DISCONTINUED;10
(b) T
HE RATE THE MATERNAL HEALTH -CARE SERVICES HAD BEEN11
PROVIDED AT IN THE PREVIOUS YEAR;12
(c) T
HE NUMBER AND TYPE OF HEALTH -CARE PROVIDERS13
IMPACTED;14
(d) T
HE PROPOSED PLAN FOR TRANSITIONING PATIENTS TO NEW15
HEALTH-CARE PROVIDERS; AND16
(e) T
HE PROPOSED PLAN FOR TRANSITIONING THE HEALTH -CARE17
PROVIDERS TO NEW POSITIONS.18
(3) (a) I
N THE EVENT OF AN EMERGENCY , A FACILITY SHALL
19
PROVIDE THE NOTICE REQUIRED IN SUBSECTION (1) OF THIS SECTION ON20
THE DAY A DEFINITIVE PLAN FOR ALTERNATIVE PATIENT CARE HAS BEEN21
ARRANGED OR WITHIN SEVEN DAYS AFTER THE EMERGENCY HAS BEEN22
IDENTIFIED, WHICHEVER IS EARLIER.23
(b) T
HIS SUBSECTION (3) DOES NOT APPLY IN THE EVENT OF AN
24
EMERGENCY COVERED BY RULES PROMULGATED BY THE DEPARTMENT OF25
PUBLIC HEALTH AND ENVIRONMENT IF SUCH EMERGENCY AFFECTS THE26
PHYSICAL SPACE OF THE FACILITY AND NECESSITATES THE REMOVAL OF27
1262
-8- CLIENTS, EMPLOYEES, OR CONTRACTORS FROM THE FACILITY .1
(4) AS USED IN THIS SECTION:2
(a) "E
MERGENCY" MEANS A SUDDEN AND UNFORESEEN
3
CIRCUMSTANCE OR FINANCIAL IMPEDIMENT THAT WOULD INHIBIT A4
HOSPITAL'S ABILITY TO SAFELY AND EFFECTIVELY OPERATE A MATERNAL5
HEALTH-CARE SERVICE.6
(b) "M
ATERNAL HEALTH-CARE
SERVICES" MEANS HEALTH-CARE7
SERVICES PROVIDED TO AN INDIVIDUAL REGARDING CARE RELATED TO THE8
INDIVIDUAL'S PREGNANCY, CHILDBIRTH, AND POSTPARTUM PERIOD.9
(5) T
HIS SECTION IS REPEALED, EFFECTIVE JULY 1, 2027.
10
SECTION 6. In Colorado Revised Statutes, 25-4-2206, amend11
(2)(a)(III) introductory portion and (2)(a)(III)(J); and add (2)(a)(III)(J.5)12
as follows:13
25-4-2206. Health equity commission - creation - repeal.14
(2) (a) The commission consists of the following twenty-three members,15
who are as follows:16
(III) The executive director of the department shall appoint ten17
members who represent, to the extent practical, Colorado's diverse ethnic,18
racial, sexual orientation, gender identity, gender expression, disability,19
aging population, socioeconomic, and geographic backgrounds. Each20
person INDIVIDUAL appointed to the commission must have demonstrated21
expertise in at least one, and preferably two, of the following areas: 22
(J) Behavioral health; or23
(J.5) M
IDWIFERY; OR24
SECTION 7.
In Colorado Revised Statutes, 25-52-104, amend25
(2)(b)(II); and add (5.5) as follows:26
25-52-104. Colorado maternal mortality review committee -27
1262
-9- creation - members - duties - report to the general assembly - repeal.1
(2) (b) In appointing members to the committee, the executive director2
shall:3
(II) Ensure that committee members represent diverse4
communities and a variety of clinical, forensic, and psychosocial5
specializations and community perspectives,
INCLUDING6
COMMUNITY-BASED MIDWIFERY; and7
(5.5) THE DEPARTMENT MAY CONTRACT WITH AN INDEPENDENT8
THIRD-PARTY EVALUATOR TO:9
(a) STUDY CLOSURES, CONSOLIDATIONS, AND ACQUISITIONS10
RELATED TO PERINATAL HEALTH -CARE PRACTICES AND FACILITIES AND11
PERINATAL STATE-DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREAS ,12
AS DEFINED IN SECTION 25-1.5-402 (11), AND ASSETS AND DEFICITS13
RELATED TO PERINATAL HEALTH AND HEALTH -CARE SERVICES ACROSS THE14
STATE, NOT LIMITED TO OBSTETRIC PROVIDERS;15
(b) IDENTIFY MAJOR OUTCOME CATEGORIES AT THE CLINICAL ,16
FAMILY, COMMUNITY, AND PROVIDER LEVELS THAT THE DEPARTMENT17
SHOULD TRACK OVER TIME AND IDENTIFY RISKS AND OPPORTUNITIES18
RELATED TO CLOSURES, CONSOLIDATIONS, AND ACQUISITIONS OF19
PERINATAL HEALTH-CARE PRACTICES AND FACILITIES;20
(c) EXPLORE THE EFFECTS OF PRACTICE AND FACILITY CLOSURES21
ON MATERNAL AND INFANT HEALTH OUTCOMES AND EXPERIENCES , TO22
ILLUSTRATE STRUCTURAL NEEDS AROUND CLOSURES, WHEN APPLICABLE;23
(d) IDENTIFY RECOMMENDATIONS DURING PRACTICE AND FACILITY24
CLOSURES AND RESULTANT TRANSFERS OF CARE . THE DEPARTMENT OR25
THIRD PARTY EVALUATOR MAY USE BOTH PRIMARY AND SECONDARY DATA26
IN MAKING THE RECOMMENDATIONS . THE DEPARTMENT OR THIRD PARTY27
1262
-10- EVALUATOR SHALL USE THE MAP CREATED PURSUANT TO SUBSECTION1
(5.5)(f) OF THIS SECTION IN DEVELOPING THE RECOMMENDATIONS . THE2
RECOMMENDATIONS MUST :3
(I) INCLUDE SOLUTIONS AT THE FACILITY LEVEL , THE PRACTICE4
LEVEL, THE WORKFORCE LEVEL , THE COMMUNITY LEVEL , AND THE5
PATIENT LEVEL;6
(II) INCLUDE MINIMUM REQUIREMENTS FOR REPORTING ON7
CLOSURES, INCLUDING METRICS ON TIMELINES AND GEOGRAPHIC AREA,8
INCLUDING WHETHER THE TIMELINE CREATED IN SECTION 25-3-131 IS9
APPROPRIATE;10
(III) DEVELOP RECOMMENDATIONS ON PRIMARY AND SECONDARY11
DATA COLLECTION RELATED TO CLOSURES AND RESULTANT TRANSFERS OF12
CARE.13
(e) IDENTIFY BEST PRACTICE GUIDELINES DURING PRACTICE AND14
FACILITY CLOSURES AND RESULTANT TRANSFERS OF CARE . THE THIRD15
PARTY EVALUATOR MAY USE BOTH PRIMARY AND SECONDARY DATA IN16
IDENTIFYING THE BEST PRACTICE GUIDELINES . THE THIRD PARTY17
EVALUATOR SHALL USE THE MAP CREATED PURSUANT TO SUBSECTION18
(5.5)(f) OF THIS SECTION IN DEVELOPING THE GUIDELINES. THE GUIDELINES19
MUST CONSIDER THE FOLLOWING AREAS : RISKS AND OPPORTUNITIES;20
TRANSFERS OF CARE; COMMUNITY NOTICE NEEDS AND OPPORTUNITIES ;21
NOTIFICATION TO THE DEPARTMENT; CLOSURE TIMELINE; AND RESOURCES22
NEEDED BY FACILITIES, PROVIDERS, AND FAMILIES.23
(f) CREATE A HEALTH PROFESSIONAL SHORTAGE AREA AND24
PERINATAL HEALTH SERVICES ASSETS AND DEFICITS ASSET MAP THAT25
IDENTIFIES BY PERINATAL SERVICE AREA:26
(I) PRIMARY HEALTH-CARE PROVIDERS, INCLUDING PHYSICIANS27
1262
-11- AND MIDWIVES OF ALL CREDENTIAL TYPES WHO PROVIDE OR COULD BE1
PROVIDING PERINATAL HEALTH CARE ;2
(II) THE TYPE AND LOCATION OF PERINATAL HEALTH CARE3
OFFERED BY THE PROVIDERS LISTED PURSUANT TO SUBSECTION (5.5)(f)(I)4
OF THIS SECTION;5
(III) COMMUNITY-BASED PERINATAL HEALTH -CARE WORKERS,6
SUCH AS DOULAS, CHILDBIRTH EDUCATORS, AND LACTATION SUPPORT7
CONSULTANTS; AND8
(IV) RESOURCES SUCH AS COMMUNITY ADVOCATES , GATHERING9
PLACES, AND EDUCATIONAL HUBS;10
(g) BY JULY 1, 2026, DELIVER THE BEST PRACTICES AND11
RECOMMENDATIONS CREATED PURSUANT TO THIS SUBSECTION (5.5) TO12
THE HOUSE OF REPRESENTATIVES HEALTH AND HUMAN SERVICES13
COMMITTEE AND THE SENATE HEALTH AND HUMAN SERVICES COMMI TTEE ,14
OR THEIR SUCCESSOR COMMITTEES .15
SECTION 8. In Colorado Revised Statutes, 24-33.5-704.5,16
amend (1)(b)(II)(G) and (1)(b)(II)(H); and add (1)(b)(II)(I) as follows:17
24-33.5-704.5. Governor's expert emergency epidemic18
response committee - creation. (1) (b) (II) In addition to the state19
members of the committee, the governor shall appoint to the committee20
an individual from each of the following categories:21
(G) A wildlife disease specialist with the division of wildlife; and22
(H) A pharmacist member of the state board of pharmacy;
AND23
(I) A
MIDWIFE WITH EXPERIENCE IN OUT-OF-HOSPITAL BIRTHS.24
25
SECTION 9. Appropriation. (1) For the 2024-25 state fiscal26
year, $328,946 is appropriated to the department of public health and27
1262
-12- environment for use by the prevention services division. This1
appropriation is from the general fund. To implement this act, the division2
may use this appropriation for maternal and child health related to3
community health, which amount is based on an assumption that the4
division will require an additional 0.8 FTE.5
(2) For the 2024-25 state fiscal year, $111,072 is appropriated to6
the department of regulatory agencies. This appropriation is from the7
general fund. To implement this act, the department may use this8
appropriation as follows:9
(a) $54,717 from general fund for use by the civil rights division10
for personal services, which amount is based on an assumption that the11
division will require an additional 1.0 FTE;12
(b) $7,950 from general fund for use by the civil rights division13
for operating expenses; 14
15
(c) $32,005 from general fund for the purchase of legal services;16
and17
(d) $16,400 from general fund for the purchase of information18
technology services. 19
(3) For the 2024-25 state fiscal year, $32,005 is appropriated to20
the department of law. This appropriation is from reappropriated funds21
received from the department of regulatory agencies under subsection22
(2)(c) of this section and is based on an assumption that the department23
of law will require an additional 0.1 FTE. To implement this act, the24
department of law may use this appropriation to provide legal services for25
the department of regulatory agencies.26
(4) For the 2024-25 state fiscal year, $16,400 is appropriated to27
1262
-13- the office of the governor for use by the office of information technology.1
This appropriation is from reappropriated funds received from the2
department of regulatory agencies under subsection (2)(d) of this section.3
To implement this act, the office may use this appropriation to provide4
information technology services for the department of regulatory5
agencies.6
SECTION 10. Safety clause. The general assembly finds,7
determines, and declares that this act is necessary for the immediate8
preservation of the public peace, health, or safety or for appropriations for9
the support and maintenance of the departments of the state and state10
institutions.11
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