HOUSE BILL 24-1262
BY REPRESENTATIVE(S) 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, Amabile, Lindsay, Lukens, Ricks,
Valdez, Vigil, Weissman, McCluskie;
also SENATOR(S) Buckner and Michaelson Jenet, Bridges, Coleman,
Danielson, Exum, Ginal, Gonzales, Hansen, Hinrichsen, Jaquez Lewis,
Kolker, Marchman, Priola, Roberts, Sullivan, Zenzinger.
C
ONCERNING MATERNAL HEALTH , 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) With the increased demand for reproductive health-care services
in the state, it is important to support the full infrastructure of reproductive
health-care providers. This includes:
(I) Integrating the services and expertise of direct-entry midwives;
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. (II) Assessing and maintaining the level of reproductive health-care
services needed in a community in a way that is accessible to the
community;
(III) Understanding the assets and the gaps in services at the county
level; and
(IV) Understanding and implementing best practices for when
services are discontinued in a community, including providing notice and
a transition plan to the state in order to recognize and monitor the ongoing
impact to the community.
(b) Demand for community birth options jumped 30% from 2019 to
2020, with the majority of demand coming from Black and Latinx birthing
people;
(c) People are choosing community birth care because they find it
supportive of not just their health needs but their social, spiritual, and
community values and needs; however, community birth facilities and
providers face barriers to providing care;
(d) Patients should have the ability to choose the provider that is
right for them, regardless of the setting. Especially for underserved Black,
Indigenous, Asian, rural, refugee, or immigrant communities or someone
dealing with a substance use or mental health condition, the ability to
choose a provider that can meet their needs isn't just important, it could be
lifesaving.
(e) Facility and practice closures leave communities scrambling
when they close suddenly and without guidance to patients. When closures
occur, the state must ensure that vulnerable communities are protected.
(f) The preventable maternal mortality crisis is only growing worse
in our state, disproportionately harming Black and Indigenous people; and
(g) The maternal mortality review committee has made several
recommendations to combat this crisis, including:
(I) Increased access to a variety of health-care professionals, such
PAGE 2-HOUSE BILL 24-1262 as direct-entry midwives;
(II) Addressing critical maternal health workforce shortages, such
as ensuring that direct-entry midwives can provide care at their full scope
and preventing perinatal facility and practice closures as much as possible;
(III) Examining unintended consequences of policies and
procedures, such as exploring the impact of facility and practice closures on
Black, Indigenous, Latinx, Asian, rural, and immigrant and refugee
communities; and
(IV) The Colorado department of public health and environment
recommends that health-care providers be trained and prepared to provide
a type of care that direct-entry midwives already specialize in. The
midwifery model of care exemplifies certain recommendations such as dyad
care, trauma-informed care, shared decision-making, and expertise in safe
transitions, care navigation, and wraparound services.
SECTION 2. In Colorado Revised Statutes, amend 12-225-114 as
follows:
12-225-114. Repeal of article - subject to review. This article 225
is repealed, effective September 1, 2028. Before the repeal, the registering
of direct-entry midwives by the division is scheduled for review in
accordance with section 24-34-104.
SECTION 3. In Colorado Revised Statutes, 24-34-305, amend
(1)(k) as follows:
24-34-305. Powers and duties of commission. (1) The commission
has the following powers and duties:
(k) (I) To receive reports from people alleging
MISTREATMENT IN
THE CONTEXT OF
maternity care, INCLUDING CARE that is not organized for,
and provided to, a person who is pregnant or in the postpartum period
AS
DEFINED IN SECTION
12-225-103, in a manner that is culturally congruent;
maintains
THAT FAILS TO MAINTAIN the person's dignity, privacy, and
confidentiality; ensures THAT FAILS TO ENSURE freedom from harm and
mistreatment; and enables THAT FAILS TO ENABLE informed choices and
continuous support.
PAGE 3-HOUSE BILL 24-1262 (II) REPORTS SHALL BE COLLECTED IN A WAY TO ENSURE THAT :
(A) C
ONFIDENTIAL INFORMATION CAN BE DE -IDENTIFIED;
(B) I
NDIVIDUALS CAN IDENTIFY MISTREATMENT THEY EXPERIENCED
BASED ON THE FOLLOWING MISTREATMENT INDEX CATEGORIES
: PHYSICAL
ABUSE
, SEXUAL ABUSE, VERBAL ABUSE, STIGMA AND DISCRIMINATION ,
FAILURE TO MEET PROFESSIONAL STANDARDS OF CARE , OR POOR RAPPORT
BETWEEN PATIENTS OR CLIENTS AND PROVIDERS
; POOR CONDITIONS AND
CONSTRAINTS PRESENTED BY THE HEALTH
-CARE SYSTEM; AND OBSTETRIC
RACISM
;
(C) N
UMBERS OF REPORTS BASED ON TYPOLOGY CAN BE GENERATED
AND SHARED WITH THE PUBLIC AND OTHER AGENCIES
;
(D) A
N INDIVIDUAL MAY IDENTIFY ANY PROTECTED CLASS THE
INDIVIDUAL MAY BE PART OF AND THAT MAY HAVE FACTORED INTO THE
INDIVIDUAL
'S MISTREATMENT;
(E) A
N INDIVIDUAL MAY INDICATE WHAT MIGHT HAVE BEEN DONE
DIFFERENTLY TO IMPROVE THE INDIVIDUAL
'S SITUATION;
(F) A
N INDIVIDUAL MAY ENTER NARRATIVE INFORMATION IN THE
INDIVIDUAL
'S OWN WORDS; AND
(G) AN INDIVIDUAL MAY VOLUNTARILY SHARE THE INDIVIDUAL 'S
CONTACT INFORMATION AND INDICATE WHETHER THE INDIVIDUAL CONSENTS
TO BEING CONTACTED BY THE DEPARTMENT OF REGULATORY AGENCIES OR
THE DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
.
(III) T
HE COMMISSION SHALL GENERATE DE -IDENTIFIED COMPOSITE
INFORMATION BASED ON REPORTS SUBMITTED PURSUANT TO THIS
SUBSECTION
(1)(k). NOTWITHSTANDING SECTION 24-1-136 (11)(a)(I), NO
LATER THAN
JULY 1, 2025, AND NO LATER THAN JULY 1 EVERY THREE YEARS
THEREAFTER
, THE COMMISSION SHALL SHARE THE GENERATED
DE
-IDENTIFIED COMPOSITE INFORMATION WITH :
(A) T
HE COLORADO MATERNAL MORTALITY REVIEW COMMITTEE
CREATED IN SECTION
25-52-104 (1);
PAGE 4-HOUSE BILL 24-1262 (B) THE HOUSE OF REPRESENTATIVES HEALTH AND HUMAN SERVICES
COMMITTEE AND THE SENATE HEALTH AND HUMAN SERVICES COMMITTEE
,
OR THEIR SUCCESSOR COMMITTEES ; AND
(C) THE MATERNITY ADVISORY COMMITTEE DEFINED IN SECTION
25.5-4-506 (1)(b).
(IV) R
EPORTS MAY BE SHARED INTERNALLY WITH STAFF FOR STUDY ,
INVESTIGATION, REPORTS, PUBLICATIONS, OR HEARINGS.
SECTION 4. In Colorado Revised Statutes, 25-1-134, amend
(2)(c)(IV) as follows:
25-1-134. Environmental justice - ombudsperson - advisory
board - grant program - definitions - repeal. (2) Environmental justice
advisory board. (c) The advisory board consists of the following twelve
members who, to the extent practicable, must reside in different geographic
areas of the state, reflect the racial and ethnic diversity of the state, and have
experience with a range of environmental issues, including air pollution,
water contamination, and public health impacts:
(IV) Four voting members appointed by the executive director of the
department,
AT LEAST ONE OF WHOM MUST BE A MIDWIFE WHO IS
PRACTICING IN A FREESTANDING BIRTH CENTER
, IN A RURAL AREA, OR AS A
HOME BIRTH PROVIDER
.
SECTION 5. In Colorado Revised Statutes, add 25-3-131 as
follows:
25-3-131. Maternal health-care services - discontinuation -
required notifications - definition - repeal. (1) E
XCEPT AS PROVIDED IN
SUBSECTION
(3) OF THIS SECTION, AT LEAST NINETY DAYS BEFORE A
HOSPITAL PROVIDING MATERNAL HEALTH
-CARE SERVICES OR A BIRTH
CENTER MAY DISCONTINUE SUCH SERVICES
, THE FACILITY SHALL PROVIDE
NOTICE TO
:
(a) T
HE DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
RESPONSIBLE FOR LICENSING HEALTH FACILITIES PURSUANT TO SECTION
25-3-101;
PAGE 5-HOUSE BILL 24-1262 (b) THE PRIMARY CARE OFFICE, CREATED IN SECTION 25-1.5-403;
(c) T
HE GOVERNOR;
(d) A
LL PATIENTS RECEIVING MATERNAL HEALTH -CARE SERVICES AT
THE FACILITY AS OF THE DATE OF THE NOTICE
;
(e) A
LL HEALTH-CARE PROVIDERS THAT PROVIDE MATERNAL
HEALTH
-CARE SERVICES FOR THE FACILITY AS OF THE DATE OF THE NOTICE ;
AND
(f) THE GENERAL PUBLIC.
(2) T
HE NOTICE REQUIRED IN SUBSECTION (1) OF THIS SECTION MUST
INCLUDE
:
(a) A
DESCRIPTION OF THE MATERNAL HEALTH-CARE SERVICES BEING
DISCONTINUED
;
(b) T
HE RATE THE MATERNAL HEALTH -CARE SERVICES HAD BEEN
PROVIDED AT IN THE PREVIOUS YEAR
;
(c) T
HE NUMBER AND TYPE OF HEALTH-CARE PROVIDERS IMPACTED;
(d) T
HE PROPOSED PLAN FOR TRANSITIONING PATIENTS TO NEW
HEALTH
-CARE PROVIDERS; AND
(e) THE PROPOSED PLAN FOR TRANSITIONING THE HEALTH -CARE
PROVIDERS TO NEW POSITIONS
.
(3) (a) I
N THE EVENT OF AN EMERGENCY, A FACILITY SHALL PROVIDE
THE NOTICE REQUIRED IN SUBSECTION
(1) OF THIS SECTION ON THE DAY A
DEFINITIVE PLAN FOR ALTERNATIVE PATIENT CARE HAS BEEN ARRANGED OR
WITHIN SEVEN DAYS AFTER THE EMERGENCY HAS BEEN IDENTIFIED
,
WHICHEVER IS EARLIER.
(b) T
HIS SUBSECTION (3) DOES NOT APPLY IN THE EVENT OF AN
EMERGENCY COVERED BY RULES PROMULGATED BY THE DEPARTMENT OF
PUBLIC HEALTH AND ENVIRONMENT IF SUCH EMERGENCY AFFECTS THE
PHYSICAL SPACE OF THE FACILITY AND NECESSITATES THE REMOVAL OF
PAGE 6-HOUSE BILL 24-1262 CLIENTS, EMPLOYEES, OR CONTRACTORS FROM THE FACILITY .
(4) A
S USED IN THIS SECTION:
(a) "E
MERGENCY" MEANS A SUDDEN AND UNFORESEEN
CIRCUMSTANCE OR FINANCIAL IMPEDIMENT THAT WOULD INHIBIT A
HOSPITAL
'S ABILITY TO SAFELY AND EFFECTIVELY OPERATE A MATERNAL
HEALTH
-CARE SERVICE.
(b) "M
ATERNAL HEALTH-CARE SERVICES" MEANS HEALTH-CARE
SERVICES PROVIDED TO AN INDIVIDUAL REGARDING CARE RELATED TO THE
INDIVIDUAL
'S PREGNANCY, CHILDBIRTH, AND POSTPARTUM PERIOD.
(5) T
HIS SECTION IS REPEALED, EFFECTIVE JULY 1, 2027.
SECTION 6. In Colorado Revised Statutes, 25-4-2206, amend
(2)(a)(III) introductory portion and (2)(a)(III)(J); and add (2)(a)(III)(J.5) as
follows:
25-4-2206. Health equity commission - creation - repeal.
(2) (a) The commission consists of the following twenty-three members,
who are as follows:
(III) The executive director of the department shall appoint ten
members who represent, to the extent practical, Colorado's diverse ethnic,
racial, sexual orientation, gender identity, gender expression, disability,
aging population, socioeconomic, and geographic backgrounds. Each
person
INDIVIDUAL appointed to the commission must have demonstrated
expertise in at least one, and preferably two, of the following areas:
(J) Behavioral health; or
(J.5) MIDWIFERY; OR
SECTION 7. In Colorado Revised Statutes, 25-52-104, amend
(2)(b)(II); and add (5.5) as follows:
25-52-104. Colorado maternal mortality review committee -
creation - members - duties - report to the general assembly - repeal.
(2) (b) In appointing members to the committee, the executive director
PAGE 7-HOUSE BILL 24-1262 shall:
(II) Ensure that committee members represent diverse communities
and a variety of clinical, forensic, and psychosocial specializations and
community perspectives,
INCLUDING COMMUNITY -BASED MIDWIFERY; and
(5.5) T
HE DEPARTMENT MAY CONTRACT WITH AN INDEPENDENT
THIRD
-PARTY EVALUATOR TO:
(a) S
TUDY CLOSURES, CONSOLIDATIONS, AND ACQUISITIONS RELATED
TO PERINATAL HEALTH
-CARE PRACTICES AND FACILITIES AND PERINATAL
STATE
-DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREAS , AS DEFINED
IN SECTION
25-1.5-402 (11), AND ASSETS AND DEFICITS RELATED TO
PERINATAL HEALTH AND HEALTH
-CARE SERVICES ACROSS THE STATE, NOT
LIMITED TO OBSTETRIC PROVIDERS
;
(b) I
DENTIFY MAJOR OUTCOME CATEGORIES AT THE CLINICAL ,
FAMILY, COMMUNITY, AND PROVIDER LEVELS THAT THE DEPARTMENT
SHOULD TRACK OVER TIME AND IDENTIFY RISKS AND OPPORTUNITIES
RELATED TO CLOSURES
, CONSOLIDATIONS, AND ACQUISITIONS OF PERINATAL
HEALTH
-CARE PRACTICES AND FACILITIES;
(c) E
XPLORE THE EFFECTS OF PRACTICE AND FACILITY CLOSURES ON
MATERNAL AND INFANT HEALTH OUTCOMES AND EXPERIENCES
, TO
ILLUSTRATE STRUCTURAL NEEDS AROUND CLOSURES
, WHEN APPLICABLE;
(d) I
DENTIFY RECOMMENDATIONS DURING PRACTICE AND FACILITY
CLOSURES AND RESULTANT TRANSFERS OF CARE
. THE DEPARTMENT OR
THIRD PARTY EVALUATOR MAY USE BOTH PRIMARY AND SECONDARY DATA
IN MAKING THE RECOMMENDATIONS
. THE DEPARTMENT OR THIRD PARTY
EVALUATOR SHALL USE THE MAP CREATED PURSUANT TO SUBSECTION
(5.5)(f) OF THIS SECTION IN DEVELOPING THE RECOMMENDATIONS . THE
RECOMMENDATIONS MUST
:
(I) I
NCLUDE SOLUTIONS AT THE FACILITY LEVEL , THE PRACTICE
LEVEL
, THE WORKFORCE LEVEL, THE COMMUNITY LEVEL, AND THE PATIENT
LEVEL
;
(II) I
NCLUDE MINIMUM REQUIREMENTS FOR REPORTING ON
CLOSURES
, INCLUDING METRICS ON TIMELINES AND GEOGRAPHIC AREA ,
PAGE 8-HOUSE BILL 24-1262 INCLUDING WHETHER THE TIMELINE CREATED IN SECTION 25-3-131 IS
APPROPRIATE
;
(III) D
EVELOP RECOMMENDATIONS ON PRIMARY AND SECONDARY
DATA COLLECTION RELATED TO CLOSURES AND RESULTANT TRANSFERS OF
CARE
.
(e) I
DENTIFY BEST PRACTICE GUIDELINES DURING PRACTICE AND
FACILITY CLOSURES AND RESULTANT TRANSFERS OF CARE
. THE THIRD PARTY
EVALUATOR MAY USE BOTH PRIMARY AND SECONDARY DATA IN IDENTIFYING
THE BEST PRACTICE GUIDELINES
. THE THIRD PARTY EVALUATOR SHALL USE
THE MAP CREATED PURSUANT TO SUBSECTION
(5.5)(f) OF THIS SECTION IN
DEVELOPING THE GUIDELINES
. THE GUIDELINES MUST CONSIDER THE
FOLLOWING AREAS
: RISKS AND OPPORTUNITIES; TRANSFERS OF CARE;
COMMUNITY NOTICE NEEDS AND OPPORTUNITIES ; NOTIFICATION TO THE
DEPARTMENT
; CLOSURE TIMELINE; AND RESOURCES NEEDED BY FACILITIES,
PROVIDERS, AND FAMILIES.
(f) C
REATE A HEALTH PROFESSIONAL SHORTAGE AREA AND
PERINATAL HEALTH SERVICES ASSETS AND DEFICITS ASSET MAP THAT
IDENTIFIES BY PERINATAL SERVICE AREA
:
(I) P
RIMARY HEALTH-CARE PROVIDERS, INCLUDING PHYSICIANS AND
MIDWIVES OF ALL CREDENTIAL TYPES WHO PROVIDE OR COULD BE PROVIDING
PERINATAL HEALTH CARE
;
(II) T
HE TYPE AND LOCATION OF PERINATAL HEALTH CARE OFFERED
BY THE PROVIDERS LISTED PURSUANT TO SUBSECTION
(5.5)(f)(I) OF THIS
SECTION
;
(III) C
OMMUNITY-BASED PERINATAL HEALTH-CARE WORKERS, SUCH
AS DOULAS
, CHILDBIRTH EDUCATORS , AND LACTATION SUPPORT
CONSULTANTS
; AND
(IV) RESOURCES SUCH AS COMMUNITY ADVOCATES , GATHERING
PLACES
, AND EDUCATIONAL HUBS;
(g) B
Y JULY 1, 2026, DELIVER THE BEST PRACTICES AND
RECOMMENDATIONS CREATED PURSUANT TO THIS SUBSECTION
(5.5) TO THE
HOUSE OF REPRESENTATIVES HEALTH AND HUMAN SERVICES COMMITTEE
PAGE 9-HOUSE BILL 24-1262 AND THE SENATE HEALTH AND HUMAN SERVICES COMMITTEE , OR THEIR
SUCCESSOR COMMITTEES
.
SECTION 8. In Colorado Revised Statutes, 24-33.5-704.5, amend
(1)(b)(II)(G) and (1)(b)(II)(H); and add (1)(b)(II)(I) as follows:
24-33.5-704.5. Governor's expert emergency epidemic response
committee - creation. (1) (b) (II) In addition to the state members of the
committee, the governor shall appoint to the committee an individual from
each of the following categories:
(G) A wildlife disease specialist with the division of wildlife; and
(H) A pharmacist member of the state board of pharmacy; AND
(I) A MIDWIFE WITH EXPERIENCE IN OUT-OF-HOSPITAL BIRTHS.
SECTION 9. Appropriation. (1) For the 2024-25 state fiscal year,
$328,946 is appropriated to the department of public health and
environment for use by the prevention services division. This appropriation
is from the general fund. To implement this act, the division may use this
appropriation for maternal and child health related to community health,
which amount is based on an assumption that the division will require an
additional 0.8 FTE.
(2) For the 2024-25 state fiscal year, $111,072 is appropriated to the
department of regulatory agencies. This appropriation is from the general
fund. To implement this act, the department may use this appropriation as
follows:
(a) $54,717 from general fund for use by the civil rights division for
personal services, which amount is based on an assumption that the division
will require an additional 1.0 FTE;
(b) $7,950 from general fund for use by the civil rights division for
operating expenses;
(c) $32,005 from general fund for the purchase of legal services; and
(d) $16,400 from general fund for the purchase of information
PAGE 10-HOUSE BILL 24-1262 technology services.
(3) For the 2024-25 state fiscal year, $32,005 is appropriated to the
department of law. This appropriation is from reappropriated funds received
from the department of regulatory agencies under subsection (2)(c) of this
section and is based on an assumption that the department of law will
require an additional 0.1 FTE. To implement this act, the department of law
may use this appropriation to provide legal services for the department of
regulatory agencies.
(4) For the 2024-25 state fiscal year, $16,400 is appropriated to the
office of the governor for use by the office of information technology. This
appropriation is from reappropriated funds received from the department of
regulatory agencies under subsection (2)(d) of this section. To implement
this act, the office may use this appropriation to provide information
technology services for the department of regulatory agencies.
SECTION 10. Safety clause. The general assembly finds,
determines, and declares that this act is necessary for the immediate
preservation of the public peace, health, or safety or for appropriations for
PAGE 11-HOUSE BILL 24-1262 the support and maintenance of the departments of the state and state
institutions.
____________________________ ____________________________
Julie McCluskie Steve Fenberg
SPEAKER OF THE HOUSE PRESIDENT OF
OF REPRESENTATIVES THE SENATE
____________________________ ____________________________
Robin Jones Cindi L. Markwell
CHIEF CLERK OF THE HOUSE SECRETARY OF
OF REPRESENTATIVES THE SENATE
APPROVED________________________________________
(Date and Time)
_________________________________________
Jared S. Polis
GOVERNOR OF THE STATE OF COLORADO
PAGE 12-HOUSE BILL 24-1262