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March 25, 2024 HB 24-1262
Legislative Council Staff
Nonpartisan Services for Colorado’s Legislature
Revised Fiscal Note
(replaces fiscal note dated February 26, 2024)
Drafting Number:
Prime Sponsors:
LLS 24-0285
Rep. Garcia; Jodeh
Sen. Buckner; Michaelson Jenet
Date:
Bill Status:
Fiscal Analyst:
March 25, 2024
House Appropriations
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 $622,313 to multiple state
agencies.
Fiscal Note
Status:
The fiscal note reflects the introduced bill, as amended by the House Health and
Human Services Committee.
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 $3,815 $3,815 -
Total Revenue $3,815 $3,815 -
Expenditures General Fund $614,614 $327,354 $284,291
Cash Funds $7,699 - -
Centrally Appropriated $70,537 $68,617 $58,874
Total Expenditures $692,850 $395,971 $343,165
Total FTE 4.2 FTE 4.1 FTE 3.6 FTE
Transfers - - - -
Other Budget Impacts TABOR Refund $3,815 $3,815 -
General Fund Reserve $92,192 $49,103 $42,644
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March 25, 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 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 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.
State Revenue
State revenue to the Division of Professions and Occupations Cash Fund in DORA is estimated to
increase by approximately $3,800 in FY 2024-25 and FY 2025-26. The division 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 Page 3
March 25, 2024 HB 24-1262
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 $330 109 $3,815
FY 2025-26 Midwife License $295 $330 109 $3,815
State Expenditures
The bill increases state expenditures in the Division of Professions and Occupations in DORA by
approximately $10,000 in FY 2024-25 only, paid from the Division of 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 $345,000 in FY 2024-25, $85,000 in
FY 2025-26, and $32,417 in FY 2025-26, paid from the General Fund. Expenditures are shown in
Table 3 and detailed below.
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 - -
Centrally Appropriated Costs
1
$1,920 - -
FTE – Personal Services 0.1 FTE - -
DPO-DORA Subtotal $9,620 - -
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 Page 4
March 25, 2024 HB 24-1262
Table 3
Expenditures Under HB 24-1262 (Cont.)
FY 2024-25 FY 2025-26 FY 2026-27
Department of Public Health and Environment
Personal Services $68,548 $68,548 $26,125
Operating Expenses $1,024 $1,024 $384
Capital Outlay Costs $7,337 - -
Third-Party Evaluator $225,000 - -
Heat Map – System Update/Outreach $27,037 - -
Centrally Appropriated Costs
1
$15,651 $15,651 $5,908
FTE – Personal Services 0.8 FTE 0.8 FTE 0.3 FTE
CDPHE Subtotal $344,597 $85,223 $32,417
Total $692,850 $395,971 $343,165
Total FTE
4.2 FTE 4.1 FTE 3.6 FTE
1
Centrally appropriated costs are not included in the bill's appropriation.
Division of Professions and Occupations, DORA. 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. Costs for the Division of Professions and Occupations are
paid from license fees on certified professional midwives.
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
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. Page 5
March 25, 2024 HB 24-1262
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 health
professional shortage area and perinatal health services assets and deficits map.
Staff. The CDPHE requires 0.8 FTE in FY 2024-25 and FY 2025-26, and 0.3 FTE in FY 2026-27,
to manage the contract with the third-party evaluator and develop the asset and deficit map.
Beginning in FY 2024-25, 0.5 FTE will provide programmatic oversight of the evaluation and
map, as well as develop eligibility criteria, build the application process, write the Request for
Proposals, and contract with an entity performing the perinatal health care evaluation. An
additional 0.3 FTE will develop the asset and deficit map. The fiscal note assumes developing
the 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, 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 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 3.
Effective Date
The bill takes effect upon signature of the Governor, or upon becoming law without his signature.
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March 25, 2024 HB 24-1262
State Appropriations
For FY 2024-25, the bill requires a General Fund appropriation of $614,613, 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
$328,946 is appropriated to the Department of Public Health and Environment, and 0.8 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 Law 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.