Page 1
February 26, 2024 HB 24-1262
Legislative Council Staff
Nonpartisan Services for Colorado’s Legislature
Fiscal Note
Drafting Number:
Prime Sponsors:
LLS 24-0285
Rep. Garcia; Jodeh
Sen. Buckner; Michaelson Jenet
Date:
Bill Status:
Fiscal Analyst:
February 26, 2024
House Health & Human Services
Shukria Maktabi | 303-866-4720
shukria.maktabi@coleg.gov
Bill Topic: MATERNAL HEALTH MIDWIVES
Summary of
Fiscal Impact:
☒ State Revenue
☒ State Expenditure
☐ State Transfer
☐ TABOR Refund
☐ Local Government
☐ Statutory Public Entity
The bill modifies and creates new measures for midwife licensure and maternal health
care. It increases state revenue and expenditures beginning in FY 2024-25.
Appropriation
Summary:
For FY 2024-25, the bill requires an appropriation of $642,440 to multiple state
agencies.
Fiscal Note
Status:
The fiscal note reflects the introduced bill.
Table 1
State Fiscal Impacts Under HB 24-1262
Budget Year
FY 2024-25
Out Year
FY 2025-26
Out Year
FY 2026-27
Revenue Cash Funds $9,701 $19,947 $19,947
Total Revenue $9,701 $19,947 $19,947
Expenditures General Fund $634,740 $323,999 $274,336
Cash Funds $7,699 $17,899 $17,899
Centrally Appropriated $75,848 $70,223 $58,720
Total Expenditures $718,287 $412,121 $350,956
Total FTE 4.5 FTE 4.2 FTE 3.6 FTE
Transfers - - - -
Other Budget Impacts TABOR Refund $9,701 $19,947 $19,947
General Fund Reserve $95,211 $48,600 $41,150
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February 26, 2024 HB 24-1262
Summary of Legislation
The bill modifies and creates new measures for midwife licensure and around maternal health
care, as detailed below.
Midwife Licensure
Direct-entry midwives are currently licensed by the Department of Regulatory Agencies (DORA);
however, statute refers to this licensure as registration. Direct-entry midwives are also currently
required to have certain certifications to be licensed that would allow them the designation as
certified professional midwives. The bill codifies current practice by updating references of
“registration” to “licensure” and “direct-entry midwife” to “certified professional midwife,” and
clarifies certification requirements.
The bill also creates a three-member Advisory Panel that will provide recommendations on
disciplinary actions against certified professional midwives beginning July 1, 2025. It requires the
membership of certain committees, boards, and programs to include midwifery expertise,
including the Environmental Justice Advisory Board, the Health Equity Commission, the
Governor’s Expert Emergency Epidemic Response Committee, and the Short-Term Health Care
Credentials program.
Maternity Care
The bill requires the Colorado Civil Rights Division within DORA to collect reports of
mistreatments in the context of maternity care in ways that allow data to be accessible
(confidential information can be de-identified and reports can be generated for the public) and
expands the information that can be provided by individuals. It also requires the commission to
submit de-identified reports of mistreatments to certain commissions and the General
Assembly.
The bill adds pregnancy as a protected class for purposes of discrimination in places of public
accommodation.
The bill requires the Colorado Maternal Mortality Review Committee in the Department of Public
Health and Environment (CDPHE) to contract a third-party evaluator to study closures and
availability of perinatal health care, impacts on affected populations, and provide
recommendations to the General Assembly by July 1, 2026.
Finally, the bill requires health care facilities that reduce or discontinue maternal health care
services to provide notice to the CDPHE, the Colorado Maternal Mortality Review Committee,
the Governor, the public, and any affected patients and providers.
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February 26, 2024 HB 24-1262
State Revenue
State revenue to the Division of Professions and Occupations Cash Fund in DORA is estimated to
increase by approximately $10,000 in FY 2024-25 and $20,000 in FY 2025-26 and ongoing years.
The division of will adjusts its fees to cover its estimated costs to implement the bill. Revenue to
the cash fund is subject to the state’s TABOR limit.
Fee impact on certified professional midwives. Colorado law requires legislative service
agency review of measures which create or increase any fee collected by a state agency. These
fee amounts are estimates only, actual fees will be set administratively by DORA based on cash
fund balance, program costs, and the number of licenses subject to the fee. Table 2 below
identifies the fee impact of this bill.
Table 2
Fee Impact on Certified Professional Midwives
Fiscal Year Type of Fee
Current
Fee
Proposed
Fee
Number
Affected
Total Fee
Impact
FY
2024-25
Midwife License $295 $384 109 $9,701
FY 2024-25 Total $9,701
FY
2025-26
Midwife License $295 $478 109 $19,947
FY 2025-26 Total $19,947
State Expenditures
The bill increases state expenditures in the Division of Professions and Occupations in DORA by
approximately $10,000 in FY 2024-25 and $20,000 in FY 2025-26 and ongoing, paid from the
Professions and Occupations Cash Fund. It also increases state expenditures in the Civil Rights
Division in DORA by $339,000 in FY 2024-25 and $311,000 in FY 2025-26 and ongoing, paid
from the General Fund. Finally, it increases state expenditures in CDPHE by $370,000 in
FY 2024-25 and $82,000 in FY 2025-26, paid from the General Fund. Expenditures are shown in
Table 3 and detailed below.
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February 26, 2024 HB 24-1262
Table 3
Expenditures Under HB 24-1262
FY 2024-25 FY 2025-26 FY 2026-27
Division of Professions and Occupations, DORA
Personal Services $7,699 $7,699 $7,699
Contract – Investigative Services - $9,600 $9,600
Advisory Panel – Meeting Reimbursement - $600 $600
Centrally Appropriated Costs
1
$1,920 $1,920 $1,920
FTE – Personal Services 0.1 FTE 0.1 FTE 0.1 FTE
DPO-DORA Subtotal $9,620 $19,820 $19,820
Civil Rights Division, DORA
Personal Services $181,407 $181,407 $181,407
Operating Expenses $3,840 $3,840 $3,840
Capital Outlay Costs $20,010 - -
Legal Services $64,010 $64,010 $64,010
IT System Programming and Maintenance $16,400 $8,525 $8,525
Centrally Appropriated Costs
1
$52,966 $52,966 $52,966
FTE – Personal Services 3.0 FTE 3.0 FTE 3.0 FTE
FTE – Legal Services 0.3 FTE 0.3 FTE 0.3 FTE
CCRD-DORA Subtotal $338,633 $310,748 $310,748
Department of Public Health and Environment
Personal Services $88,291 $65,193 $16,298
Operating Expenses $1,408 $1,024 $256
Capital Outlay Costs $7,337 - -
Third-Party Evaluator $225,000 - -
Heat Map – System Update/Outreach $27,037 - -
Centrally Appropriated Costs
1
$20,961 $15,336 $3,834
FTE – Personal Services 1.1 FTE 0.8 FTE 0.2 FTE
CDPHE Subtotal $370,034 $81,553 $20,388
Total $718,287 $412,121 $350,956
Total FTE
4.5 FTE 4.2 FTE 3.6 FTE
1
Centrally appropriated costs are not included in the bill's appropriation. Page 5
February 26, 2024 HB 24-1262
Division of Professions and Occupations, DORA. The division will have costs to update the
midwife licensure process and support the advisory panel. The fiscal note assumes that the
panel will meet at least once per quarter to review and provide recommendations for complaints
against certified professional midwives. Costs for the Division of Professions and Occupations
are paid from license fees on certified professional midwives.
Staff. In FY 2024-25 only, the Division requires 0.1 FTE for rulemaking, performing outreach
to licensees, and updating the website and forms to reflect the profession name change.
Beginning in FY 2025-26 and in ongoing years, the division requires 0.1 FTE to provide
administrative support for the Advisory Panel meetings, including managing meeting
materials, redacting information in case documents reviewed by members, and providing
final recommendations to the director.
Contracted services for additional investigations. Beginning in FY 2025-26, the division
requires $9,600 for contracted services to perform additional investigations to gather the
information necessary to reach a decision. The fiscal note assumes the Advisory Panel will
request additional investigations for four complaints against certified professional midwives
to make their recommendation per year. Each investigation will require $2,400 of a
third-party investigator, for 40 hours of work per case at $60 per hour.
Advisory panel member reimbursement. Beginning in FY 2025-26, the division requires
$600 annually to reimburse for per-diem expenses for three advisory panel members to
attend four meetings annually.
Legal services. Beginning in FY 2025-26. the division will require legal services from the
Department of Law to provide legal counsel during advisory panel meetings. This workload
is expected to be minimal and accommodated within existing resources. Any appeals that
stem from disciplinary actions are expected to be minimal and accomplished within existing
resources.
Civil Rights Division, DORA. The Civil Rights Division requires staff, legal services, and system
updates to meet the maternity care reporting requirements of the bill and investigate claims
regarding pregnancy discrimination.
Staff. Beginning in FY 2024-25, the Division requires a total of 3.0 FTE. Of this, 1.0 FTE will
manage the reporting requirements for maternal care mistreatment, including managing the
additional data reported by individuals, developing the database to have the ability to
extract data and run reports, submitting report to committees, and managing inquiries and
following up with individuals if requested in their report. The remaining 2.0 FTE will track and
investigate claims filed with the division regarding pregnancy discrimination.
IT system updates. The division requires approximately $16,400 in FY 2024-25, and $8,525
for maintenance in ongoing years, to update online forms used by individuals to report
maternal care mistreatment; create and maintain a database that can produce reports of
de-identified data as required; and to update the online and case management system for
discrimination reports to include pregnancy as a protected class. This assumes 100 hours of Page 6
February 26, 2024 HB 24-1262
work initially at an average of $164 per hour, and 50 hours for ongoing maintenance
support. These costs are reappropriated to the Office of Information Technology.
Legal services. The division is assumed to require 500 hours of legal support annually, or
0.3 FTE, from the Department of Law for counsel around reporting on confidential health
care and advising related to pregnancy discrimination in places of public accommodation.
Department of Public Health and Environment. The CDPHE requires staff and costs to study
maternal health care services closures. This will include hiring the third-party evaluator and
updating data systems to provide them with the necessary information through a maternal
desert and asset heat map.
Staff. The CDPHE requires a total of 1.1 FTE in FY 2024-25, 0.8 FTE in FY 2025-26, and
0.2 FTE in FY 2026-27 to manage the contract with the third-party evaluator, develop the
maternal heat map, and update rules for health care facilities.
In FY 2024-25 only, 0.3 FTE will develop and add rules to health facilities regulations for
reporting reduced or discontinued maternal health care services. This includes preparing,
facilitating, and providing subject matter expertise for stakeholder meetings and board
hearings. 0.4 FTE will develop eligibility criteria, build the application process, write the
Request for Proposals, and contract with an entity performing the perinatal health care
evaluation.
In FY 2024-25 and FY 2025-26, 0.4 FTE will develop the maternal heat map. The fiscal note
assumes developing the heat map internally instead through the contracted evaluator will be
more cost-effective, as the CDPHE has the infrastructure for data collection and analysis to
build the map. Staff activities include data collection, processing, and analysis to develop the
map, as well as providing relevant data from the map to the evaluator as needed. Staff costs
are required through September 1, 2026 once final deliverables are completed.
Third-party evaluator. From FY 2024-25 to FY 2026-27, the CDPHE requires a total of
$225,000 to contract an evaluator to conduct the study for the Maternal Mortality Review
Committee on closures related to perinatal health care. This includes working with the
department and committee, collecting and analyzing data, and developing the final report.
System changes. In FY 2024-25 only, the CDPHE requires $20,000 to contract a developer to
modify existing data systems for the heat map development by CDPHE staff, including
adding data integration and reporting functions.
Outreach costs. The CDPHE requires one-time costs of $7,037 to print, send, and collect
data from digital and paper surveys for the heat map analysis and development.
Centrally appropriated costs. Pursuant to a Joint Budget Committee policy, certain costs
associated with this bill are addressed through the annual budget process and centrally
appropriated in the Long Bill or supplemental appropriations bills, rather than in this bill. These
costs, which include employee insurance and supplemental employee retirement payments, are
shown in Table 2. Page 7
February 26, 2024 HB 24-1262
Effective Date
The bill takes effect upon signature of the Governor, or upon becoming law without his signature.
State Appropriations
For FY 2024-25, the bill requires a General Fund appropriation of $634,740, of which:
$285,667 is appropriated to the Civil Rights Division in the Department of Regulatory
Agencies, and 3.0 FTE, of which $64,010 and 0.3 FTE reappropriated to the Department of
Law, and $16,400 is reappropriated to the Office of Information Technology; and
$349,073 is appropriated to the Department of Public Health and Environment, and 1.1 FTE.
The bill also requires an appropriation of $7,699 from the Division of Professions and
Occupations Cash Fund to the Department of Regulatory Agencies, and 0.1 FTE.
State and Local Government Contacts
Judicial Public Health and Environment Regulatory Agencies
The revenue and expenditure impacts in this fiscal note represent changes from current law under the bill for each
fiscal year. For additional information about fiscal notes, please visit the General Assembly website.