Second Regular Session
Seventy-fourth General Assembly
STATE OF COLORADO
INTRODUCED
LLS NO. 24-0285.01 Yelana Love x2295
HOUSE BILL 24-1262
House Committees Senate Committees
Health & Human Services
A BILL FOR AN ACT
C
ONCERNING MATERNAL HEALTH .101
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
the same updates to current law in other statutes outside of the practice
act.
HOUSE SPONSORSHIP
Garcia and Jodeh,
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. 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
services in the state, it is important to support the full infrastructure of5
HB24-1262-2- reproductive health-care providers. This includes:1
(I) Integrating the services and expertise of certified professional2
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 reduced or discontinued in a community, including providing10
notice and a transition plan to the state in order to recognize and monitor11
the 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
(d) The term "direct-entry midwife" has inconsistent meaning20
across states and causes confusion, whereas "Certified Professional21
Midwife" (CPM) more clearly communicates what these providers do in22
Colorado, and "Certified Professional Midwife" is consistent with the23
nationally recognized credential for midwives specializing in community24
birth. Colorado statutes should be updated to be consistent with other25
states and the national language.26
(e) While not reflected in statute, CPM is the credential that27
HB24-1262
-3- direct-entry midwives have been required to have to practice in Colorado,1
as the director of the division of professions and occupations started2
accepting only this credential as proof of satisfying the educational3
requirements listed in statute;4
(f) Over 95% of the direct-entry midwives actively practicing in5
the state hold the CPM credential, and those who don't have decades of6
experience;7
(g) CPMs are considered licensed in other states, including in the8
surrounding states of Wyoming, New Mexico, Utah, and Arizona.9
Colorado statutes should be updated to reflect our alignment with national10
trends and neighboring states.11
(h) Patients should have the ability to choose the provider that is12
right for them, regardless of the setting. Especially for underserved Black,13
Indigenous, Asian, rural, refugee, or immigrant communities or someone14
dealing with a substance use or mental health condition, the ability to15
choose a provider that can meet their needs isn't just important, it could16
be lifesaving.17
(i) Facility and practice closures leave communities scrambling18
when they close suddenly and without guidance to patients. When19
closures occur, the state must ensure that vulnerable communities are20
protected.21
(j) The preventable maternal mortality crisis is only growing22
worse in our state, disproportionately harming Black and Indigenous23
people; and24
(k) The maternal mortality review committee has made several25
recommendations to combat this crisis, including:26
(I) Increased access to a variety of health-care professionals, such27
HB24-1262
-4- as CPMs;1
(II) Addressing critical maternal health workforce shortages, such2
as ensuring that CPMs can provide care at their full scope and preventing3
perinatal facility and practice closures as much as possible;4
(III) Examining unintended consequences of policies and5
procedures, such as exploring the impact of facility and practice closures6
on Black, Indigenous, Latinx, Asian, rural, and immigrant and refugee7
communities; and8
(IV) The Colorado department of public health and environment9
recommends that health-care providers be trained and prepared to provide10
a type of care that CPMs already specialize in. The midwifery model of11
care exemplifies certain recommendations such as dyad care,12
trauma-informed care, shared decision-making, and expertise in safe13
transitions, care navigation, and wraparound services.14
SECTION 2. In Colorado Revised Statutes, 12-225-101, amend15
(1)(a), (1)(b), and (2) introductory portion as follows:16
12-225-101. Scope of article - exemptions - legislative17
declaration. (1) (a) This article 225 applies only to direct-entry18
CERTIFIED PROFESSIONAL midwives and does not apply to those persons19
who are otherwise licensed by the state of Colorado under this title 12 if20
the practice of midwifery is within the scope of that licensure.21
(b) (I) A person who is a certified nurse midwife authorized22
pursuant to section 12-255-111, a certified midwife authorized pursuant23
to section 12-255-111.5, or a physician as provided in article 240 of this24
title 12 shall not simultaneously be so licensed and also be registered25
LICENSED under this article 225. A physician, certified nurse midwife, or26
certified midwife who holds a license in good standing may relinquish the27
HB24-1262
-5- license and subsequently be registered LICENSED under this article 225. 1
(II) A direct-entry CERTIFIED PROFESSIONAL midwife shall not2
represent oneself as a nurse midwife, certified nurse midwife, or certified3
midwife.4
(III) The fact that a direct-entry CERTIFIED PROFESSIONAL midwife5
may hold a practical or professional nursing license does not expand the6
scope of practice of the direct-entry CERTIFIED PROFESSIONAL midwife.7
(IV) The fact that a practical or professional nurse may be8
registered LICENSED as a direct-entry CERTIFIED PROFESSIONAL midwife9
does not expand the scope of practice of the nurse.10
(2) Nothing in this article 225 shall be construed to prohibit, or to11
require registration LICENSURE under this article 225, with regard to:12
SECTION 3. In Colorado Revised Statutes, amend 12-225-10313
as follows:14
12-225-103. Definitions. As used in this article 225, unless the15
context otherwise requires:16
(1) "Birth center" means a freestanding facility licensed by the17
department of public health and environment that:18
(a) Is not a hospital, attached to a hospital, or located in a hospital;19
(b) Provides prenatal, labor, delivery, and postpartum care to20
low-risk pregnant persons and newborns; and21
(c) Provides care during delivery and immediately after delivery22
that is generally less than twenty-four hours in duration.23
(2) "C
ERTIFIED PROFESSIONAL MIDWIFE" MEANS A PERSON WHO24
PRACTICES CERTIFIED PROFESSIONAL MIDWIFERY .25
(3) "C
ERTIFIED PROFESSIONAL MIDWIFE CREDENTIAL " MEANS A26
CERTIFIED PROFESSIONAL MIDWIFE CREDENTIAL ISSUED BY THE NORTH27
HB24-1262
-6- AMERICAN REGISTRY OF MIDWIVES, OR ITS SUCCESSOR ORGANIZATION.1
(4) "C
ERTIFIED PROFESSIONAL MIDWIFERY " OR "PRACTICE OF2
CERTIFIED PROFESSIONAL MIDWIFERY " MEANS ADVISING, ATTENDING, OR3
ASSISTING AN INDIVIDUAL DURING PREGNANCY , LABOR AND NATURAL4
CHILDBIRTH AT HOME OR AT A BIRTH CENTER , AND THE POSTPARTUM5
PERIOD IN ACCORDANCE WITH THIS ARTICLE 225.6
(1.5)
(5) "Client" means a pregnant woman for whom a7
direct-entry midwife CERTIFIED PROFESSIONAL MIDWIFE performs8
services. For purposes of perinatal or postpartum care, "client" includes9
the woman's newborn.10
(2) "Direct-entry midwife" means a person who practices11
direct-entry midwifery.12
(3) "Direct-entry midwifery" or "practice of direct-entry13
midwifery" means the advising, attending, or assisting of a woman during14
pregnancy, labor and natural childbirth at home or at a birth center, and15
the postpartum period in accordance with this article 225.16
(4) (6) "Natural childbirth" means the birth of a child without the17
use of instruments, surgical procedures, or prescription drugs other than18
those for which the direct-entry CERTIFIED PROFESSIONAL midwife has19
specific authority under this article 225 to obtain and administer.20
(5) (7) "Perinatal" means the period from the twenty-eighth week21
of pregnancy through seven days after birth.22
(6) (8) "Postpartum period" means the period of six weeks after23
birth.24
SECTION 4. In Colorado Revised Statutes, 12-225-104, amend25
(1), (3), (4) introductory portion, (4)(f), (5), and (6); and add (1.5), (1.7),26
and (5.5) as follows:27
HB24-1262
-7- 12-225-104. Requirement for licensure by the division - annual1
fee - renewal - grounds for revocation - repeal. (1) (a) P
RIOR TO2
S
EPTEMBER 1, 2024, every direct-entry midwife shall register with the3
division by applying to the director in the form and manner the director4
requires. The application shall include the information specified in5
section 12-225-105.6
(b) T
HIS SUBSECTION (1) IS REPEALED, EFFECTIVE SEPTEMBER 1,7
2025.8
(1.5) O
N OR AFTER SEPTEMBER 1, 2024, EXCEPT AS OTHERWISE9
PROVIDED IN THIS ARTICLE 225, AN INDIVIDUAL IN THIS STATE WHO10
PRACTICES CERTIFIED PROFESSIONAL MIDWIFERY OR WHO REPRESENTS11
ONESELF AS BEING ABLE TO PRACTICE CERTIFIED PROFESSIONAL12
MIDWIFERY MUST POSSESS A VALID LICENSE ISSUED BY THE DIRECTOR13
PURSUANT TO THIS ARTICLE 225 AND RULES PROMULGATED PURSUANT TO14
THIS ARTICLE 225.15
(1.7) (a) O
N SEPTEMBER 1, 2024, EACH ACTIVE DIRECT-ENTRY16
MIDWIFE REGISTRATION BECOMES AN ACTIVE CERTIFIED PROFESSIONAL17
MIDWIFE LICENSE BY OPERATION OF LAW . THE CONVERSION FROM18
REGISTRATION TO LICENSURE AND DIRECT -ENTRY MIDWIFE TO CERTIFIED19
PROFESSIONAL MIDWIFE DOES NOT AFFECT ANY PRIOR DISCIPLINE ,20
LIMITATION, OR CONDITION IMPOSED BY THE DIRECTOR ON A21
DIRECT-ENTRY MIDWIFE'S REGISTRATION; LIMIT THE DIRECTOR 'S22
AUTHORITY OVER ANY REGISTRANT ; OR AFFECT ANY PENDING23
INVESTIGATION OR ADMINISTRATIVE PROCEEDING . THE DIRECTOR SHALL24
TREAT ANY APPLICATION FOR A DIRECT -ENTRY MIDWIFE REGISTRATION25
PENDING AS OF AUGUST 31, 2024, INCLUDING ANY APPLICATION FOR26
RENEWAL OR REINSTATEMENT OF A DIRECT -ENTRY MIDWIFE27
HB24-1262
-8- REGISTRATION, AS AN APPLICATION FOR A CERTIFIED PROFESSIONAL1
MIDWIFE LICENSE, WHICH APPLICATION IS SUBJECT TO THE REQUIREMENTS2
ESTABLISHED BY THE DIRECTOR.3
(b) T
HIS SUBSECTION (1.7) IS REPEALED, EFFECTIVE SEPTEMBER 1,4
2026.5
(3) Every applicant for registration
LICENSURE shall pay a6
registration LICENSURE fee to be established by the director in the manner7
authorized by section 12-20-105. Registrations LICENSES issued pursuant8
to this article 225 are subject to the renewal, expiration, reinstatement,9
and delinquency fee provisions specified in section 12-20-202 (1) and (2).10
Any person whose registration LICENSE has expired shall be IS subject to11
the penalties provided in this article 225 or section 12-20-202 (1).12
(4) To qualify to register FOR LICENSURE, a direct-entry CERTIFIED13
PROFESSIONAL midwife must have successfully completed an examination14
evaluated and approved by the director as an appropriate test to measure15
competency in the practice of direct-entry CERTIFIED PROFESSIONAL16
midwifery, which examination must have been developed by a person AN17
INDIVIDUAL or entity other than the director or the division and the18
acquisition of which shall require no expenditure of state funds. The19
national registry examination administered by the Midwives Alliance of20
North America NORTH AMERICAN REGISTRY OF MIDWIVES, or its21
successor, must be among those evaluated by the director. The director is22
authorized to approve any existing test meeting all the criteria set forth in23
this subsection (4). In addition to successfully completing the24
examination, a direct-entry CERTIFIED PROFESSIONAL midwife is qualified25
to register FOR LICENSURE if the person INDIVIDUAL has:26
(f) Filed documentation with the director that the direct-entry27
HB24-1262
-9- CERTIFIED PROFESSIONAL midwife is currently certified by the American1
Heart Association or the American Red Cross to perform adult and infant2
cardiopulmonary resuscitation ("CPR").3
(5) Effective July 1, 2003, in order to be deemed qualified to4
register, a direct-entry IN ORDER TO OBTAIN A LICENSE , A CERTIFIED5
PROFESSIONAL midwife must have graduated from an accredited6
midwifery educational program;
OBTAINED A CERTIFIED PROFESSIONAL7
MIDWIFE CREDENTIAL FROM THE NORTH AMERICAN REGISTRY OF8
M
IDWIVES, OR ITS SUCCESSOR ORGANIZATION; or obtained a substantially9
equivalent education approved by the director. The educational10
requirement does not apply to
AN INDIVIDUAL INITIALLY REGISTERED AS11
A direct-entry midwives who have registered with the division
MIDWIFE12
before July 1, 2003.13
(5.5) T
HE DIRECTOR SHALL NOT RENEW A CERTIFIED PROFESSIONAL14
MIDWIFE'S LICENSE WITHOUT PROOF THAT THE INDIVIDUAL HAS AN ACTIVE15
CERTIFIED PROFESSIONAL MIDWIFE CREDENTIAL FROM THE NORTH16
A
MERICAN REGISTRY OF MIDWIVES, OR ITS SUCCESSOR ORGANIZATION.17
(6) For purposes of registration
LICENSURE under this article 225,18
no credential, licensure, or certification issued by any other state meets19
the requirements of this article 225, and therefore there is no reciprocity20
with other states.21
SECTION 5. In Colorado Revised Statutes, 12-225-105, amend22
(1) introductory portion, (1)(a), (1)(b), (1)(c), (1)(d), (1)(e), (1)(g), and23
(1)(h) as follows:24
12-225-105. Mandatory disclosure of information to clients.25
(1) Every direct-entry CERTIFIED PROFESSIONAL midwife shall provide26
the following information in writing to each client during the initial client27
HB24-1262
-10- contact:1
(a) The name, business address, and business phone number of the2
direct-entry CERTIFIED PROFESSIONAL midwife;3
(b) A listing of the direct-entry CERTIFIED PROFESSIONAL4
midwife's education, experience, degrees, membership in any professional5
organization whose membership includes not less than one-third of all6
registrants LICENSEES, certificates or credentials related to direct-entry7
CERTIFIED PROFESSIONAL midwifery awarded by any such organization,8
and the length of time and number of contact hours required to obtain the9
degrees, certificates, or credentials;10
(c) A statement indicating whether or not the direct-entry11
CERTIFIED PROFESSIONAL midwife is covered under a policy of liability12
insurance for the practice of direct-entry CERTIFIED PROFESSIONAL13
midwifery;14
(d) A listing of any license, certificate, or registration in the15
health-care field previously or currently held by the direct-entry16
CERTIFIED PROFESSIONAL midwife and suspended or revoked by any local,17
state, or national health-care agency;18
(e) A statement that the practice of direct-entry CERTIFIED19
PROFESSIONAL midwifery is regulated by the department. The statement20
must provide the address and telephone number of the office of21
midwifery registration LICENSURE in the division and shall state that22
violation of this article 225 may result in revocation of registration23
LICENSURE and of the authority to practice direct-entry CERTIFIED24
PROFESSIONAL midwifery in Colorado.25
(g) A statement indicating whether or not the direct-entry26
CERTIFIED PROFESSIONAL midwife will administer vitamin K to the27
HB24-1262
-11- client's newborn infant and, if not, a list of qualified health-care1
practitioners who can provide that service; and2
(h) A statement indicating whether or not the direct-entry3
CERTIFIED PROFESSIONAL midwife will administer Rho(D) immune4
globulin to the client if she THE CLIENT is determined to be Rh-negative5
and, if not, a list of qualified health-care practitioners who can provide6
that service.7
SECTION 6. In Colorado Revised Statutes, 12-225-106, amend8
(1), (2), (3), (4), (5)(a) introductory portion, (5)(a)(I), (5)(a)(II), (5)(a)(III)9
introductory portion, (5)(a)(III)(A), (5)(a)(III)(C), (5)(a)(III)(E),10
(5)(a)(III)(F), (5)(a)(IV), (6), (7), (8), (9), (10), (11), (13), and (14) as11
follows:12
12-225-106. Prohibited acts - practice standards - informed13
consent - emergency plan - risk assessment - referral - rules. (1) A14
direct-entry CERTIFIED PROFESSIONAL midwife shall not dispense or15
administer any medication or drugs except in accordance with section16
12-225-107.17
(2) A direct-entry CERTIFIED PROFESSIONAL midwife shall not18
perform any operative or surgical procedure; except that a direct-entry19
CERTIFIED PROFESSIONAL midwife may perform sutures of perineal tears20
in accordance with section 12-225-107.21
(3) A direct-entry CERTIFIED PROFESSIONAL midwife shall not22
provide care to a pregnant woman who, according to generally accepted23
medical standards, exhibits signs or symptoms of increased risk of24
medical or obstetric or neonatal complications or problems during the25
completion of her pregnancy, labor, delivery, or the postpartum period.26
Those conditions include but are not limited to signs or symptoms of27
HB24-1262
-12- diabetes, multiple gestation, hypertensive disorder, or abnormal1
presentation of the fetus.2
(4) A direct-entry CERTIFIED PROFESSIONAL midwife shall not3
provide care to a pregnant woman who, according to generally accepted4
medical standards, exhibits signs or symptoms of increased risk that her5
child may develop complications or problems during the first six weeks6
of life.7
(5) (a) A direct-entry CERTIFIED PROFESSIONAL midwife shall keep8
appropriate records of midwifery-related activity, including but not9
limited to the following:10
(I) The direct-entry CERTIFIED PROFESSIONAL midwife shall11
complete and file a birth certificate for every delivery in accordance with12
section 25-2-112.13
(II) The direct-entry CERTIFIED PROFESSIONAL midwife shall14
complete and maintain appropriate client records for every client.15
(III) Before accepting a client for care, the direct-entry CERTIFIED16
PROFESSIONAL midwife shall obtain the client's informed consent, which17
shall be evidenced by a written statement in a form prescribed by the18
director and signed by both the direct-entry CERTIFIED PROFESSIONAL19
midwife and the client. The form shall MUST certify that full disclosure20
has been made and acknowledged by the client as to each of the following21
items, with the client's acknowledgment evidenced by a separate signature22
or initials adjacent to each item in addition to the client's signature at the23
end of the form:24
(A) The direct-entry CERTIFIED PROFESSIONAL midwife's25
educational background and training;26
(C) A description of the available alternatives to direct-entry27
HB24-1262
-13- CERTIFIED PROFESSIONAL midwifery care, including a statement that the1
client understands the client is not retaining a certified nurse midwife, a2
nurse midwife, or a certified midwife;3
(E) A statement indicating whether or not the direct-entry4
CERTIFIED PROFESSIONAL midwife is covered under a policy of liability5
insurance for the practice of direct-entry CERTIFIED PROFESSIONAL6
midwifery; and7
(F) A statement informing the client that, if subsequent care is8
required resulting from the acts or omissions of the direct-entry CERTIFIED9
PROFESSIONAL midwife, any physician, nurse, certified midwife,10
prehospital emergency personnel, and health-care institution rendering11
subsequent care will be held only to a standard of gross negligence or12
willful and wanton conduct MISCONDUCT;13
(IV) (A) Until the liability insurance required pursuant to section14
12-225-112 (2) is available, each direct-entry CERTIFIED PROFESSIONAL15
midwife shall, before accepting a client for care, provide the client with16
a disclosure statement indicating that the direct-entry CERTIFIED17
PROFESSIONAL midwife does not have liability insurance. To comply with18
this section, the direct-entry CERTIFIED PROFESSIONAL midwife shall19
ensure that the disclosure statement is printed in at least twelve-point20
bold-faced type and shall read the statement to the client in a language the21
client understands. Each client shall sign the disclosure statement22
acknowledging that the client understands the effect of its provisions. The23
direct-entry CERTIFIED PROFESSIONAL midwife shall also sign the24
disclosure statement and provide a copy of the signed disclosure25
statement to the client.26
(B) In addition to the information required in subsection27
HB24-1262
-14- (5)(a)(IV)(A) of this section, the direct-entry CERTIFIED PROFESSIONAL1
midwife shall include the following statement in the disclosure statement2
and shall display the statement prominently and deliver the statement3
orally to the client before the client signs the disclosure statement:4
"Signing this disclosure statement does not constitute a waiver of any5
right (insert client's name) has to seek damages or redress from the6
undersigned direct-entry CERTIFIED PROFESSIONAL midwife for any act of7
negligence or any injury (insert client's name) may sustain in the course8
of care administered by the undersigned direct-entry CERTIFIED9
PROFESSIONAL midwife."10
(6) A direct-entry CERTIFIED PROFESSIONAL midwife shall prepare11
a plan, in the form and manner required by the director, for emergency12
situations. The plan must include procedures to be followed in situations13
in which the time required for transportation to the nearest facility14
capable of providing appropriate treatment exceeds limits established by15
the director by rule. A copy of the plan shall be given to each client as16
part of the informed consent required by subsection (5) of this section.17
(7) A direct-entry CERTIFIED PROFESSIONAL midwife shall prepare18
and transmit appropriate specimens for newborn screening in accordance19
with section 25-4-1004 and shall refer every newborn child for20
evaluation, within seven days after birth, to a licensed health-care21
provider with expertise in pediatric care.22
(8) A direct-entry CERTIFIED PROFESSIONAL midwife shall ensure23
that appropriate laboratory testing, as determined by the director, is24
completed for each client.25
(9) (a) A direct-entry CERTIFIED PROFESSIONAL midwife shall26
provide eye prophylactic therapy to all newborn children in the27
HB24-1262
-15- direct-entry CERTIFIED PROFESSIONAL midwife's care in accordance with1
section 25-4-301.2
(b) A direct-entry CERTIFIED PROFESSIONAL midwife shall inform3
the parents of all newborn children in the direct-entry CERTIFIED4
PROFESSIONAL midwife's care of the importance of critical congenital5
heart defect screening using pulse oximetry in accordance with section6
25-4-1004.3. If a direct-entry CERTIFIED PROFESSIONAL midwife is not7
properly trained in the use of pulse oximetry or does not have the use of8
or own a pulse oximeter, the direct-entry CERTIFIED PROFESSIONAL9
midwife shall refer the parents to a health-care provider who can perform10
the screening. If a direct-entry CERTIFIED PROFESSIONAL midwife is11
properly trained in the use of pulse oximetry and has the use of or owns12
a pulse oximeter, the direct-entry CERTIFIED PROFESSIONAL midwife shall13
perform the critical congenital heart defect screening on newborn children14
in the direct-entry CERTIFIED PROFESSIONAL midwife's care in accordance15
with section 25-4-1004.3.16
(10) A direct-entry CERTIFIED PROFESSIONAL midwife shall be17
knowledgeable and skilled in aseptic procedures and the use of universal18
precautions and shall use them with every client.19
(11) To assure that proper risk assessment is completed and that20
clients who are inappropriate for direct-entry CERTIFIED PROFESSIONAL21
midwifery are referred to other health-care providers, the director shall22
establish, by rule, a risk assessment procedure to be followed by a23
direct-entry CERTIFIED PROFESSIONAL midwife for each client and24
standards for appropriate referral. The assessment shall be
MADE a part of25
each client's record as required in subsection (5)(a)(II) of this section.26
(13) A registered direct-entry
LICENSED CERTIFIED PROFESSIONAL27
HB24-1262
-16- midwife may purchase, possess, carry, and administer oxygen. The1
department shall promulgate rules concerning minimum training2
requirements for direct-entry CERTIFIED PROFESSIONAL midwives with3
respect to the safe administration of oxygen. Each registrant LICENSEE4
shall complete the minimum training requirements and submit proof of5
having completed the requirements to the director before administering6
oxygen to any client.7
(14) A registrant LICENSEE shall not practice beyond the scope of8
the registrant's LICENSEE'S education and training.9
SECTION 7. In Colorado Revised Statutes, 12-225-107, amend10
(1), (2) introductory portion, (3), (4), (5), (6), (7), and (8) as follows:11
12-225-107. Limited use of certain medications - emergency12
medical procedures - rules. (1) A registrant LICENSEE may obtain13
prescription medications to treat conditions specified in this section from14
a registered prescription drug outlet, registered manufacturer, or15
registered wholesaler. An entity that provides a prescription medication16
to a registrant LICENSEE in accordance with this section, and who relies17
in good faith upon the registration LICENSE information provided by the18
registrant LICENSEE, is not subject to liability for providing the19
medication.20
(2) Except as otherwise provided in subsection (3) of this section,21
a registrant LICENSEE may obtain and administer:22
(3) (a) If a client refuses a medication listed in subsection (2)(a)23
or (2)(b) of this section, the registrant LICENSEE shall provide the client24
with an informed consent form containing a detailed statement of the25
benefits of the medication and the risks of refusal and shall retain a copy26
of the form acknowledged and signed by the client.27
HB24-1262
-17- (b) If a client experiences uncontrollable postpartum hemorrhage1
and refuses treatment with antihemorrhagic drugs, the registrant LICENSEE2
shall immediately initiate the transportation of the client in accordance3
with the emergency plan
REQUIRED BY SECTION 12-225-106 (6).4
(4) A registrant
LICENSEE shall, as part of the emergency medical5
plan required by section 12-225-106 (6), inform the client that:6
(a) If she experiences uncontrollable postpartum hemorrhage, the7
registrant LICENSEE is required by Colorado law to initiate emergency8
medical treatment, which may include the administration of an9
antihemorrhagic drug by the registrant LICENSEE to mitigate the10
postpartum hemorrhaging while initiating the immediate transportation11
of the client in accordance with the emergency plan.12
(b) If she experiences postpartum hemorrhage, the registrant13
LICENSEE is prepared and equipped to administer intravenous fluids to14
restore volume lost due to excessive bleeding.15
(5) The director shall promulgate rules to implement this section.16
In promulgating the rules, the director shall seek the advice of17
knowledgeable medical professionals to set standards for education,18
training, and administration that reflect current generally accepted19
professional standards for the safe and effective use of the medications,20
methods of administration, and procedures described in this section.21
including a requirement that, to administer intravenous fluids, the22
registrant complete an intravenous therapy course or program approved23
by the director. The director shall establish a preferred drug list that24
displays the medications that a registrant can obtain.25
(6) (a) Subject to subsection (6)(b) of this section, a registrant A26
LICENSEE may perform sutures of first-degree and second-degree perineal27
HB24-1262
-18- tears, as defined by the director by rule, on a client and may administer1
local anesthetics to the client in connection with suturing perineal tears.2
(b) In order to perform sutures of first-degree and second-degree3
perineal tears, the registrant shall apply to the director, in the form and4
manner required by the director, and pay any application fee the director5
may impose, for an authorization to perform sutures of first-degree and6
second-degree perineal tears. As part of the application, the registrant7
shall demonstrate to the director that the registrant has received education8
and training approved by the director on suturing of perineal tears within9
the year immediately preceding the date of the application or within such10
other time the director, by rule, determines to be appropriate. The director11
may grant the authorization to the registrant only if the registrant has12
complied with the education and training requirement specified in this13
subsection (6)(b).14
(7) A registered direct-entry LICENSED CERTIFIED PROFESSIONAL15
midwife who was initially registered
AS A DIRECT-ENTRY MIDWIFE prior16
to January 1, 2000, must apply to the director and pay any applicable fees17
before obtaining or administering group B streptococcus (GBS)18
prophylaxis as part of the registrant's
LICENSEE'S practice of direct-entry19
CERTIFIED PROFESSIONAL midwifery. The director shall verify the20
qualifications of a registrant LICENSEE applying pursuant to this21
subsection (7) before granting the registrant LICENSEE the authority to22
obtain and administer group B streptococcus (GBS) prophylaxis.23
(8) A registrant LICENSEE who is granted authority to act pursuant24
to this section is not required to apply for renewal of the authority or pay25
any renewal fees pertaining to the authority granted in this section.26
SECTION 8. In Colorado Revised Statutes, 12-225-108, amend27
HB24-1262
-19- (1)(b), (1)(c), (1)(d), (1)(f), (1)(g), and (1)(h) as follows:1
12-225-108. Director - powers and duties - rules. (1) In2
addition to any other powers and duties conferred on the director by law,3
the director has the following powers and duties:4
(b) To establish the fees for registration LICENSURE and renewal5
of registration LICENSURE in the manner authorized by section 12-20-105;6
(c) To prepare or adopt suitable education standards for applicants7
and to adopt a registration LICENSURE examination;8
(d) To accept applications for registration LICENSURE that meet the9
requirements set forth in this article 225, and to collect the annual10
registration LICENSURE fees authorized by this article 225;11
(f) To summarily suspend a registration LICENSE upon the failure12
of the registrant LICENSEE to comply with any condition of a stipulation13
or order imposed by the director until the registrant LICENSEE complies14
with the condition, unless compliance is beyond the control of the15
registrant LICENSEE;16
(g) To develop policies and protocols, by rule, for direct-entry17
CERTIFIED PROFESSIONAL midwives in training that reflect the18
requirements of the North American Registry of Midwives, or its19
successor organization;20
(h) To order the physical or mental examination of a direct-entry21
CERTIFIED PROFESSIONAL midwife if the director has reasonable cause to22
believe that the direct-entry CERTIFIED PROFESSIONAL midwife is subject23
to a physical or mental disability that renders the direct-entry CERTIFIED24
PROFESSIONAL midwife unable to treat patients with reasonable skill and25
safety or that may endanger a patient's health or safety. The director may26
order a physical or mental examination regardless of whether there is27
HB24-1262
-20- injury to a patient.1
SECTION 9. In Colorado Revised Statutes, 12-225-109, amend2
(1), (3), (4), (5), (7), and (8) as follows:3
12-225-109. Disciplinary action authorized - grounds for4
discipline - advisory panel - injunctions - rules. (1) If a direct-entry5
CERTIFIED PROFESSIONAL midwife has violated any of the provisions of6
section 12-225-104, 12-225-105, 12-225-106, or 12-225-112 (2), the7
director may take disciplinary or other action as authorized by section8
12-20-404 or seek an injunction against a direct-entry THE CERTIFIED9
PROFESSIONAL midwife in accordance with section 12-20-406 to enjoin10
the direct-entry CERTIFIED PROFESSIONAL midwife from practicing11
midwifery or committing a violation specified in this subsection (1). 12
(3) (a) The director,
AFTER CONSIDERING THE RECOMMENDATION13
OF THE ADVISORY PANEL CREATED IN SUBSECTION (3)(b) OF THIS SECTION,14
may take disciplinary action as authorized by section 12-20-404 (1)(a),15
(1)(b), or (1)(d) for any of the following acts or omissions:16
(a)
(I) Any violation of section 12-225-104, 12-225-105,17
12-225-106, or 12-225-112 (2) or an applicable provision of article 20 or18
30 of this title 12;19
(b) (II) Failing to provide any information required pursuant to,20
or to pay any fee assessed in accordance with, section 12-225-104 or21
providing false, deceptive, or misleading information to the division that22
the direct-entry CERTIFIED PROFESSIONAL midwife knew or should23
reasonably have known was false, deceptive, or misleading;24
(c) (III) Failing to respond in an honest, materially responsive, and25
timely manner to a letter of complaint from the director;26
(d) (IV) Failing to comply with an order of the director, including27
HB24-1262
-21- an order placing conditions or restrictions on the registrant's LICENSEE'S1
practice;2
(e) (V) Engaging in any act or omission that does not meet3
generally accepted standards of safe care for women and infants, whether4
or not actual injury to a client is established;5
(f) (VI) Abuse or habitual or excessive use of a habit-forming6
drug, a controlled substance as defined in section 18-18-102 (5), or7
alcohol;8
(g) (VII) Procuring or attempting to procure a registration LICENSE9
in this or any other state or jurisdiction by fraud, deceit,10
misrepresentation, misleading omission, or material misstatement of fact;11
(h) (VIII) Having had a license or registration to practice12
direct-entry CERTIFIED PROFESSIONAL midwifery or any other health-care13
profession or occupation suspended or revoked in any jurisdiction;14
(i) (IX) Violating any law or regulation governing the practice of15
direct-entry CERTIFIED PROFESSIONAL midwifery in another state or16
jurisdiction. A plea of nolo contendere or its equivalent accepted by any17
state agency of another state or jurisdiction may be considered to be the18
same as a finding of violation for purposes of a proceeding under this19
article 225.20
(j) (X) Falsifying, failing to make essential entries in, or in a21
negligent manner making incorrect entries in client records;22
(k) (XI) Conviction of a felony or acceptance by a court of a plea23
of guilty or nolo contendere to a felony. A certified copy of the judgment24
of a court of competent jurisdiction of a conviction or plea shall be prima25
facie evidence of the conviction.26
(l) (XII) Aiding or knowingly permitting any person to violate any27
HB24-1262
-22- provision of this article 225 or an applicable provision of article 20 or 301
of this title 12;2
(m) (XIII) Advertising through newspapers, magazines, circulars,3
direct mail, directories, radio, television, website, e-mail, text message,4
or otherwise that the registrant LICENSEE will perform any act prohibited5
by this article 225; or6
(n) (I) (XIV) (A) Failing to notify the director, as required by7
section 12-30-108 (1), of a physical illness, physical condition, or8
behavioral, mental health, or substance use disorder that renders the9
registrant LICENSEE unable, or limits the registrant's LICENSEE'S ability, to10
practice direct-entry CERTIFIED PROFESSIONAL midwifery with reasonable11
skill and safety to the client;12
(II) (B) Failing to act within the limitations created by a physical13
illness, physical condition, or behavioral, mental health, or substance use14
disorder that renders the registrant LICENSEE unable to practice15
direct-entry CERTIFIED PROFESSIONAL midwifery with reasonable skill and16
safety or that may endanger the health or safety of persons under the17
registrant's LICENSEE'S care; or18
(III) (C) Failing to comply with the limitations agreed to under a19
confidential agreement entered pursuant to sections 12-30-108 and20
12-225-111.21
(b) (I) T
HE DIRECTOR SHALL ESTABLISH AN ADVISORY PANEL TO22
PROVIDE RECOMMENDATIONS TO THE DIRECTOR ON WHETHER TO TAKE23
DISCIPLINARY ACTION PURSUANT TO SUBSECTION (3)(a) OF THIS SECTION.24
(II) T
HE ADVISORY PANEL CONSISTS OF THREE MEMBERS25
APPOINTED BY THE DIRECTOR WHO ARE CERTIFIED PROFESSIONAL26
MIDWIVES.27
HB24-1262
-23- (III) THE DIRECTOR SHALL MAKE THE INITIAL APPOINTMENTS TO1
THE ADVISORY PANEL NO LATER THAN JULY 1, 2025. THE TERM OF2
APPOINTMENT IS TWO YEARS ; EXCEPT THAT THE TERM OF ONE OF THE3
MEMBERS INITIALLY APPOINTED IS ONE YEAR . A MEMBER MAY SERVE NO4
MORE THAN TWO CONSECUTIVE TERMS . A PERSON WHO HAS SERVED TWO5
CONSECUTIVE TERMS MAY BE REAPPOINTED TO THE PANEL AFTER AT6
LEAST ONE YEAR HAS PASSED SINCE THE PERSON LAST SERVED ON THE7
PANEL.8
(IV) M
EMBERS OF THE ADVISORY PANEL SERVE WITHOUT9
COMPENSATION BUT ARE ENTITLED TO RECEIVE REIMBURSEMENT FOR10
ACTUAL AND NECESSARY EXPENSES INCURRED IN THE PERFORMANCE OF11
THE MEMBERS' DUTIES ON THE ADVISORY PANEL.12
(V) I
F, AFTER INVESTIGATION OF A COMPLAINT , THE DIRECTOR13
FINDS THE COMPLAINT HAS MERIT, THE DIRECTOR SHALL ORGANIZE AND14
CALL THE ADVISORY PANEL TO INVESTIGATE THE COMPLAINT .15
(VI) T
HE DIRECTOR SHALL PROVIDE THE ADVISORY PANEL WITH16
ALL INFORMATION COLLECTED AS PART OF THE INVESTIGATION , REDACTED17
TO PROTECT THE NAMES OF ALL PARTIES , INCLUDING THE INDIVIDUAL18
BEING INVESTIGATED.19
(VII) T
HE ADVISORY PANEL SHALL REVIEW THE INFORMATION AND20
PROVIDE THE DIRECTOR WITH A RECOMMENDATION ON WHETHER21
ADDITIONAL INFORMATION SHOULD BE GATHERED AS PART OF THE22
INVESTIGATION, INCLUDING THE KIND OF INFORMATION AND23
RECOMMENDED APPROACH TO COLLECTING IT , WHETHER DISCIPLINE IS24
WARRANTED, AND, IF DISCIPLINE IS WARRANTED, THE RECOMMENDED25
TYPE OF DISCIPLINE PURSUANT TO SUBSECTION (4), (7), OR (8) OF THIS26
SECTION.27
HB24-1262
-24- (VIII) THE DIRECTOR SHALL CONSIDER THE RECOMMENDATION OF1
THE ADVISORY PANEL PROVIDED IN ACCORDANCE WITH SUBSECTION2
(3)(b)(VII)
OF THIS SECTION BEFORE DETERMINING THE DISPOSITION OF3
THE CASE.4
(IX) T
HE DIRECTOR SHALL PROVIDE THE PANEL 'S5
RECOMMENDATION TO THE INDIVIDUAL WHO IS THE SUBJECT OF A6
COMPLAINT AND SHALL INCLUDE THE COMPLAINT IN THE INDIVIDUAL 'S7
CASE FILE.8
(4) Any proceeding to deny, suspend, or revoke a registration
9
LICENSE or place a registrant LICENSEE on probation shall be conducted10
pursuant to sections 12-20-403, 24-4-104, and 24-4-105. Section11
12-20-408 governs judicial review of any final decision of the director.12
(5) The director
OR ADVISORY PANEL may accept as prima facie13
evidence of grounds for disciplinary action any disciplinary action taken14
against a registrant
LICENSEE by another jurisdiction if the violation that15
prompted the disciplinary action would be grounds for disciplinary action16
under this article 225.17
(7) The director may issue and send a letter of admonition to a18
registrant LICENSEE under the circumstances specified in and in19
accordance with section 12-20-404 (4).20
(8) The director may send a confidential letter of concern to a21
registrant LICENSEE under the circumstances specified in section22
12-20-404 (5).23
SECTION 10. In Colorado Revised Statutes, amend 12-225-11024
as follows:25
12-225-110. Unauthorized practice - penalties. Any person26
INDIVIDUAL who practices or offers or attempts to practice direct-entry27
HB24-1262
-25- CERTIFIED PROFESSIONAL midwifery OR USES THE TITLE "CERTIFIED1
PROFESSIONAL MIDWIFE" without an active registration LICENSE issued2
under this article 225 is subject to penalties pursuant to section 12-20-4073
(1)(a).4
SECTION 11. In Colorado Revised Statutes, amend 12-225-1125
as follows:6
12-225-112. Assumption of risk - no vicarious liability -7
professional liability insurance required. (1) It is the policy of this8
state that registrants LICENSEES are liable for their acts or omissions in the9
performance of the services that they provide, and that no licensed10
physician, nurse, certified midwife, prehospital emergency medical11
personnel, or health-care institution is liable for any act or omission12
resulting from the administration of services by any registrant LICENSEE.13
This subsection (1) does not relieve any physician, nurse, certified14
midwife, prehospital emergency personnel, or health-care institution from15
liability for any willful and wanton act or omission or any act or omission16
constituting gross negligence or under circumstances where a registrant17
LICENSEE has a business or supervised relationship with the physician,18
nurse, certified midwife, prehospital emergency personnel, or health-care19
institution. A physician, nurse, certified midwife, prehospital emergency20
personnel, or health-care institution may provide consultation or21
education to the registrant LICENSEE without establishing a business or22
supervisory relationship and is encouraged to accept referrals from23
registrants LICENSEES pursuant to this article 225.24
(2) If the director finds that liability insurance is available at an25
affordable price, registrants LICENSEES shall be required to carry liability26
insurance.27
HB24-1262
-26- SECTION 12. In Colorado Revised Statutes, amend 12-225-1141
as follows:2
12-225-114. Repeal of article - subject to review. This article3
225 is repealed, effective September 1, 2028. Before the repeal, the4
registering of direct-entry LICENSURE OF CERTIFIED PROFESSIONAL5
midwives by the division is scheduled for review in accordance with6
section 24-34-104.7
SECTION 13. In Colorado Revised Statutes, 23-3.3-1009,8
amend (2)(c) as follows:9
23-3.3-1009. Support for in-demand short-term health-care10
credentials - report - definitions - repeal. (2) The state board for11
community colleges and occupational education shall allocate money to12
community colleges, area technical colleges, local district colleges, and13
community not-for-profit organizations that deliver hybrid programming14
that leverages place-based supports in partnership with local district15
colleges, community colleges, and area technical colleges through16
reimbursement based on students enrolled in eligible programs for fiscal17
years 2022-23 to 2025-26 to:18
(c) If unexpended resources exist or if the program use is less than19
anticipated, to expand eligible programs in allied health based on20
in-demand credential needs,
INCLUDING CERTIFIED PROFESSIONAL21
MIDWIFERY, or include high school equivalency support and attainment22
for students without a high school degree who participate in the program.23
SECTION 14. In Colorado Revised Statutes, 24-34-305, amend24
(1)(k) as follows:25
24-34-305. Powers and duties of commission. (1) The26
commission has the following powers and duties:27
HB24-1262
-27- (k) (I) To receive reports from people alleging MISTREATMENT IN1
THE CONTEXT OF maternity care, INCLUDING CARE that is not organized2
for, and provided to, a person who is pregnant or in the postpartum period3
AS DEFINED IN SECTION 12-225-103, in a manner that is culturally4
congruent; maintains
THAT FAILS TO MAINTAIN the person's dignity,5
privacy, and confidentiality; ensures THAT FAILS TO ENSURE freedom from6
harm and mistreatment; and enables THAT FAILS TO ENABLE informed7
choices and continuous support.8
(II) R
EPORTS SHALL BE COLLECTED IN A WAY TO ENSURE THAT :9
(A) C
ONFIDENTIAL INFORMATION CAN BE DE -IDENTIFIED;10
(B) I
NDIVIDUALS CAN IDENTIFY MISTREATMENT THEY11
EXPERIENCED BASED ON THE FOLLOWING MISTREATMENT INDEX12
CATEGORIES: PHYSICAL ABUSE, SEXUAL ABUSE, VERBAL ABUSE, STIGMA13
AND DISCRIMINATION, FAILURE TO MEET PROFESSIONAL STANDARDS OF14
CARE, OR POOR RAPPORT BETWEEN PATIENTS OR CLIENTS AND PROVIDERS ;15
POOR CONDITIONS AND CONSTRAINTS PRESENTED BY THE HEALTH -CARE16
SYSTEM; AND OBSTETRIC RACISM;17
(C) N
UMBERS OF REPORTS BASED ON TOPOLOGY CAN BE18
GENERATED AND SHARED WITH THE PUBLIC AND OTHER AGENCIES ;19
(D) A
N INDIVIDUAL MAY IDENTIFY ANY PROTECTED CLASS THE20
INDIVIDUAL MAY BE PART OF AND THAT MAY HAVE FACTORED INTO THE21
INDIVIDUAL'S MISTREATMENT;22
(E) A
N INDIVIDUAL MAY INDICATE WHAT MIGHT HAVE BEEN DONE23
DIFFERENTLY TO IMPROVE THE INDIVIDUAL 'S SITUATION;24
(F) A
N INDIVIDUAL MAY ENTER NARRATIVE INFORMATION IN THE25
INDIVIDUAL'S OWN WORDS; AND26
(G) A
N INDIVIDUAL MAY VOLUNTARILY SHARE THE INDIVIDUAL 'S27
HB24-1262
-28- CONTACT INFORMATION AND INDICATE WHETHER THE INDIVI DUAL1
CONSENTS TO BEING CONTACTED BY THE DEPARTMENT OF REGULATORY2
AGENCIES OR THE DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT . 3
(III) T
HE COMMISSION SHALL GENERATE DE -IDENTIFIED4
COMPOSITE INFORMATION BASED ON REPORTS SUBMITTED PURSUANT TO5
THIS SUBSECTION (1)(k). NOTWITHSTANDING SECTION 24-1-136 (11)(a)(I),6
NO LATER THAN JULY 1, 2025, AND NO LATER THAN JULY 1 EVERY THREE7
YEARS THEREAFTER, THE COMMISSION SHALL SHARE THE GENERATED8
DE-IDENTIFIED COMPOSITE INFORMATION WITH :9
(A) T
HE COLORADO MATERNAL MORTALITY REVIEW COMMITTEE10
CREATED IN SECTION 25-52-104 (1);11
(B) T
HE HOUSE OF REPRESENTATIVES HEALTH AND HUMAN12
SERVICES COMMITTEE AND THE SENATE HEALTH AND HUMAN SERVICES13
COMMITTEE, OR THEIR SUCCESSOR COMMITTEES ; AND14
(C) T
HE MATERNITY ADVISORY COMMITTEE DEFINED IN SECTION15
25.5-4-506 (1)(b).16
(IV) R
EPORTS MAY BE SHARED INTERNALLY WITH STAFF FOR17
STUDY, INVESTIGATION, REPORTS, PUBLICATIONS, OR HEARINGS.18
SECTION 15. In Colorado Revised Statutes, 24-34-601, amend19
(2)(a) as follows:20
24-34-601. Discrimination in places of public accommodation21
- definition. (2) (a) It is a discriminatory practice and unlawful for a22
person, directly or indirectly, to refuse, withhold from, or deny to an23
individual or a group, because of disability, race, creed, color, sex, sexual24
orientation, gender identity, gender expression,
PREGNANCY, marital25
status, national origin, or ancestry, the full and equal enjoyment of the26
goods, services, facilities, privileges, advantages, or accommodations of27
HB24-1262
-29- a place of public accommodation or, directly or indirectly, to publish,1
circulate, issue, display, post, or mail any written, electronic, or printed2
communication, notice, or advertisement that indicates that the full and3
equal enjoyment of the goods, services, facilities, privileges, advantages,4
or accommodations of a place of public accommodation will be refused,5
withheld from, or denied an individual or that an individual's patronage6
or presence at a place of public accommodation is unwelcome,7
objectionable, unacceptable, or undesirable because of disability, race,8
creed, color, sex, sexual orientation, gender identity, gender expression,9
PREGNANCY, marital status, national origin, or ancestry.10
SECTION 16. In Colorado Revised Statutes, 25-1-134, amend11
(2)(c)(IV) as follows:12
25-1-134. Environmental justice - ombudsperson - advisory13
board - grant program - definitions - repeal. (2) Environmental14
justice advisory board. (c) The advisory board consists of the following15
twelve members who, to the extent practicable, must reside in different16
geographic areas of the state, reflect the racial and ethnic diversity of the17
state, and have experience with a range of environmental issues, including18
air pollution, water contamination, and public health impacts:19
(IV) Four voting members appointed by the executive director of20
the department,
AT LEAST ONE OF WHOM MUST BE A MIDWIFE WHO IS21
PRACTICING IN A FREESTANDING BIRTH CENTER , IN A RURAL AREA, OR AS22
A HOME BIRTH PROVIDER.23
SECTION 17. In Colorado Revised Statutes, add 25-3-131 as24
follows:25
25-3-131. Maternal health-care services - reduction or26
discontinuation - required notifications - definition. (1) A
T LEAST27
HB24-1262
-30- NINETY DAYS BEFORE A HEALTH -CARE FACILITY THAT PROVIDES1
MATERNAL HEALTH-CARE SERVICES MAY REDUCE OR DISCONTINUE SUCH2
SERVICES, THE FACILITY SHALL PROVIDE NOTICE TO:3
(a) T
HE HEALTH FACILITIES AND EMERGENCY MEDICAL SERVICES4
DIVISION OF THE DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT ;5
(b) T
HE COLORADO MATERNAL MORTALITY REVIEW COMMITTEE6
CREATED IN SECTION 25-52-104 (1);7
(c) T
HE GOVERNOR;8
(d) A
LL PATIENTS RECEIVING MATERNAL HEALTH -CARE SERVICES9
AT THE FACILITY AS OF THE DATE OF THE NOTICE;10
(e) A
LL HEALTH-CARE PROVIDERS THAT PROVIDE MATERNAL11
HEALTH-CARE SERVICES FOR THE FACILITY AS OF THE DATE OF THE12
NOTICE; AND13
(f) T
HE GENERAL PUBLIC.14
(2) T
HE NOTICE REQUIRED IN SUBSECTION (1) OF THIS SECTION15
MUST INCLUDE:16
(a) A
DESCRIPTION OF THE MATERNAL HEALTH -CARE SERVICES17
BEING REDUCED OR DISCONTINUED ;18
(b) T
HE RATE THE MATERNAL HEALTH -CARE SERVICES HAD BEEN19
PROVIDED AT IN THE PREVIOUS YEAR;20
(c) T
HE NUMBER AND TYPE OF HEALTH -CARE PROVIDERS21
IMPACTED;22
(d) T
HE PROPOSED PLAN FOR TRANSITIONING PATIENTS TO NEW23
HEALTH-CARE PROVIDERS; AND24
(e) T
HE PROPOSED PLAN FOR TRANSITIONING THE HEALTH -CARE25
PROVIDERS TO NEW POSITIONS.26
(3) A
S USED IN THIS SECTION , "MATERNAL HEALTH -CARE27
HB24-1262
-31- SERVICES" MEANS HEALTH-CARE SERVICES PROVIDED TO AN INDIVIDUAL1
DURING THE INDIVIDUAL'S PREGNANCY, CHILDBIRTH, AND POSTPARTUM2
PERIOD.3
SECTION 18. In Colorado Revised Statutes, 25-4-2206, amend4
(2)(a)(III) introductory portion and (2)(a)(III)(J); and add (2)(a)(III)(J.5)5
as follows:6
25-4-2206. Health equity commission - creation - repeal.7
(2) (a) The commission consists of the following twenty-three members,8
who are as follows:9
(III) The executive director of the department shall appoint ten10
members who represent, to the extent practical, Colorado's diverse ethnic,11
racial, sexual orientation, gender identity, gender expression, disability,12
aging population, socioeconomic, and geographic backgrounds. Each13
person INDIVIDUAL appointed to the commission must have demonstrated14
expertise in at least one, and preferably two, of the following areas: 15
(J) Behavioral health; or16
(J.5) M
IDWIFERY; OR17
SECTION 19. In Colorado Revised Statutes, 25-52-104, amend18
(2)(b)(II), (4)(f), and (4)(g); and add (4)(h) as follows:19
25-52-104. Colorado maternal mortality review committee -20
creation - members - duties - report to the general assembly - repeal.21
(2) (b) In appointing members to the committee, the executive director22
shall:23
(II) Ensure that committee members represent diverse24
communities and a variety of clinical, forensic, and psychosocial25
specializations and community perspectives,
INCLUDING26
COMMUNITY-BASED MIDWIFERY; and27
HB24-1262
-32- (4) The committee shall:1
(f) Perform any other functions as resources allow to enhance the2
capability of the state to reduce and prevent maternal mortality; and3
(g) Advise the department in the department's work on decreasing4
maternal mortality;
AND5
(h) C
ONTRACT WITH AN INDEPENDENT THIRD -PARTY EVALUATOR6
TO:7
(I) S
TUDY CLOSURES RELATED TO PERINATAL HEALTH -CARE8
PRACTICES AND FACILITIES AND PERINATAL HEALTH -CARE DESERTS AND9
ASSETS RELATED TO PERINATAL HEALTH AND HEALTH -CARE SERVICES10
ACROSS THE STATE, NOT LIMITED TO OBSTETRIC PROVIDERS;11
(II) I
DENTIFY MAJOR OUTCOME CATEGORIES AT THE CLINICAL ,12
FAMILY, COMMUNITY, AND PROVIDER LEVELS THAT THE DEPARTMENT13
SHOULD TRACK OVER TIME AND IDENTIFY RISKS AND OPPORTUNITIES ;14
(III) E
XPLORE THE EFFECTS OF PRACTICE AND FACILITY CLOSURES15
ON MATERNAL AND INFANT HEALTH OUTCOMES AND EXPERIENCES , TO16
ILLUSTRATE STRUCTURAL NEEDS AROUND CLOSURES ;17
(IV) I
DENTIFY RECOMMENDATIONS DURING PRACTICE AND18
FACILITY CLOSURES AND RESULTANT TRANSFERS OF CARE . THE THIRD19
PARTY EVALUATOR MAY USE BOTH PRIMARY AND SECONDARY DATA IN20
MAKING THE RECOMMENDATIONS . THE THIRD PARTY EVALUATOR SHALL21
USE THE MAP CREATED PURSUANT TO SUBSECTION (4)(h)(VI) OF THIS22
SECTION IN DEVELOPING THE RECOMMENDATIONS . THE23
RECOMMENDATIONS MUST :24
(A) I
NCLUDE SOLUTIONS AT THE FACILITY LEVEL , THE PRACTICE25
LEVEL, THE WORKFORCE LEVEL , THE COMMUNITY LEVEL , AND THE26
PATIENT LEVEL;27
HB24-1262
-33- (B) INCLUDE MINIMUM REQUIREMENTS FOR REPORTING ON1
CLOSURES, INCLUDING METRICS ON TIMELINES AND GEOGRAPHIC AREA ;2
(C) D
EVELOP RECOMMENDATIONS ON PRIMARY AND SECONDARY3
DATA COLLECTION RELATED TO CLOSURES AND RESULTANT TRANSFERS OF4
CARE.5
(V) I
DENTIFY BEST PRACTICE GUIDELINES DURING PRACTICE AND6
FACILITY CLOSURES AND RESULTANT TRANSFERS OF CARE . THE THIRD7
PARTY EVALUATOR MAY USE BOTH PRIMARY AND SECONDARY DATA IN8
IDENTIFYING THE BEST PRACTICE GUIDELINES . THE THIRD PARTY9
EVALUATOR SHALL USE THE MAP CREATED PURSUANT TO SUBSECTION10
(4)(h)(VI)
OF THIS SECTION IN DEVELOPING THE GUIDELINES . THE11
GUIDELINES MUST CONSIDER THE FOLLOWING AREAS : RISKS AND12
OPPORTUNITIES; TRANSFERS OF CARE; COMMUNITY NOTICE NEEDS AND13
OPPORTUNITIES; NOTIFICATION TO THE DEPARTMENT; CLOSURE TIMELINE;14
AND RESOURCES NEEDED BY FACILITIES , PROVIDERS, AND FAMILIES.15
(VI) C
REATE A MATERNAL HEALTH DESERT AND ASSET MAP THAT16
IDENTIFIES BY COUNTY:17
(A) P
RIMARY HEALTH-CARE PROVIDERS, INCLUDING PHYSICIANS18
AND MIDWIVES OF ALL CREDENTIAL TYPES WHO PROVIDE OR COULD BE19
PROVIDING PERINATAL HEALTH CARE ;20
(B) T
HE TYPE AND LOCATION OF PERINATAL HEALTH CARE21
OFFERED BY THE PROVIDERS LISTED PURSUANT TO SUBSECTION22
(4)(h)(VI)(A)
OF THIS SECTION;23
(C) C
OMMUNITY-BASED PERINATAL HEALTH -CARE WORKERS,24
SUCH AS DOULAS, CHILDBIRTH EDUCATORS, AND LACTATION SUPPORT25
CONSULTANTS; AND26
(D)
RESOURCES SUCH AS COMMUNITY ADVOCATES , GATHERING27
HB24-1262
-34- PLACES, AND EDUCATIONAL HUBS;1
(VII) B
Y JULY 1, 2026, DELIVER THE BEST PRACTICES AND2
RECOMMENDATIONS CREATED PURSUANT TO THIS SUBSECTION (4)(h) TO3
THE HOUSE OF REPRESENTATIVES HEALTH AND HUMAN SERVICES4
COMMITTEE AND THE SENATE HEALTH AND HUMAN SERVICES COMMITTEE ,5
OR THEIR SUCCESSOR COMMITTEES .6
SECTION 20. In Colorado Revised Statutes, 24-33.5-704.5,7
amend (1)(b)(II)(G) and (1)(b)(II)(H); and add (1)(b)(II)(I) as follows:8
24-33.5-704.5. Governor's expert emergency epidemic9
response committee - creation. (1) (b) (II) In addition to the state10
members of the committee, the governor shall appoint to the committee11
an individual from each of the following categories:12
(G) A wildlife disease specialist with the division of wildlife; and
13
(H) A pharmacist member of the state board of pharmacy;
AND14
(I) A
MIDWIFE WITH EXPERIENCE IN OUT-OF-HOSPITAL BIRTHS.15
SECTION 21. In Colorado Revised Statutes, 12-20-202, amend16
(3)(e)(X) as follows:17
12-20-202. Licenses, certifications, and registrations - renewal18
- reinstatement - fees - occupational credential portability program19
- temporary authority for military spouses - exceptions for military20
personnel - rules - consideration of criminal convictions or driver's21
history - executive director authority - definitions. (3) Occupational22
credential portability program. (e) Subsections (3)(a) to (3)(d) of this23
section do not apply to the following professions or occupations:24
(X) Direct-entry
CERTIFIED PROFESSIONAL midwives, regulated25
pursuant to article 225 of this title 12; or26
SECTION 22. In Colorado Revised Statutes, 12-20-404, amend27
HB24-1262
-35- (1)(d)(II)(H) as follows:1
12-20-404. Disciplinary actions - regulator powers -2
disposition of fines - mistreatment of at-risk adult - exceptions -3
definitions. (1) General disciplinary authority. If a regulator4
determines that an applicant, licensee, certificate holder, or registrant has5
committed an act or engaged in conduct that constitutes grounds for6
discipline or unprofessional conduct under a part or article of this title 127
governing the particular profession or occupation, the regulator may:8
(d) (II) A regulator is not authorized under this subsection (1)(d)9
to refuse to renew the license, certification, or registration of a licensee,10
certificate holder, or registrant regulated under the following:11
(H) Article 225 of this title 12 concerning direct-entry CERTIFIED12
PROFESSIONAL midwives;13
SECTION 23. In Colorado Revised Statutes, 12-20-407, amend14
(1)(a)(V)(K) and (1)(e)(V) as follows:15
12-20-407. Unauthorized practice of profession or occupation16
- penalties - exclusions. (1) (a) A person commits a class 2 misdemeanor17
and shall be punished as provided in section 18-1.3-501 if the person:18
(V) Practices or offers or attempts to practice any of the following19
professions or occupations without an active license, certification, or20
registration issued under the part or article of this title 12 governing the21
particular profession or occupation:22
(K) Direct-entry CERTIFIED PROFESSIONAL midwifery, as regulated23
under article 225 of this title 12;24
(e) A person commits a class 6 felony and shall be punished as25
provided in section 18-1.3-401 if the person practices or offers or26
attempts to practice any of the following professions or occupations and27
HB24-1262
-36- intentionally and fraudulently represents oneself as a licensed, certified,1
or registered professional or practitioner pursuant to a part or article of2
this title 12 governing the particular profession or occupation:3
(V) Direct-entry CERTIFIED PROFESSIONAL midwifery, as regulated4
pursuant to article 225 of this title 12;5
SECTION 24. In Colorado Revised Statutes, 12-20-408, amend6
(1)(c) as follows:7
12-20-408. Judicial review. (1) Except as specified in subsection8
(2) of this section, the court of appeals has initial jurisdiction to review9
all final actions and orders of a regulator that are subject to judicial10
review and shall conduct the judicial review proceedings in accordance11
with section 24-4-106 (11); except that, with regard only to12
cease-and-desist orders, a district court of competent jurisdiction has13
initial jurisdiction to review a final action or order of a regulator that is14
subject to judicial review and shall conduct the judicial review15
proceedings in accordance with section 24-4-106 (3) for the following:16
(c) Article 225 of this title 12 concerning direct-entry CERTIFIED17
PROFESSIONAL midwives;18
SECTION 25. In Colorado Revised Statutes, 12-30-102, amend19
(3)(a)(X) as follows:20
12-30-102. Medical transparency act of 2010 - disclosure of21
information about health-care providers - fines - rules - short title -22
legislative declaration - review of functions - definition - repeal.23
(3) (a) As used in this section, "applicant" means a person applying for24
a new, active license, certification, or registration or to renew, reinstate,25
or reactivate an active license, certification, or registration to practice:26
(X) Direct-entry CERTIFIED PROFESSIONAL midwifery pursuant to27
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-37- article 225 of this title 12;1
SECTION 26. In Colorado Revised Statutes, 12-30-122, amend2
(6)(d)(III) and (6)(d)(IV) as follows:3
12-30-122. Intimate examination of sedated or unconscious4
patient - informed consent required - definitions. (6) As used in this5
section:6
(d) "Licensee" means:7
(III) An advanced practice registered nurse, as defined in section8
12-255-104 (1); a registered nurse, as defined in section 12-255-104 (11);9
or a midwife, other than a direct-entry CERTIFIED PROFESSIONAL midwife10
or certified nurse midwife, practicing in this state whose scope of practice11
includes performing intimate examinations; or12
(IV) A direct-entry CERTIFIED PROFESSIONAL midwife registered13
pursuant to article 225 of this title 12.14
SECTION 27. In Colorado Revised Statutes, 13-21-115.5,15
amend (3)(c)(II)(C) as follows:16
13-21-115.5. Volunteer service act - immunity - exception for17
operation of motor vehicles - short title - legislative declaration -18
definitions. (3) As used in this section, unless the context otherwise19
requires:20
(c) (II) "Volunteer" includes:21
(C) A registered direct-entry LICENSED CERTIFIED PROFESSIONAL22
midwife governed by article 225 of title 12 performing the practice of23
direct-entry CERTIFIED PROFESSIONAL midwifery, as defined in section24
12-225-103 (3) 12-225-103 (4), as a volunteer for a nonprofit25
organization, a nonprofit corporation, a governmental entity, or a hospital;26
SECTION 28. In Colorado Revised Statutes, 24-34-104, amend27
HB24-1262
-38- (29)(a)(XV) as follows:1
24-34-104. General assembly review of regulatory agencies2
and functions for repeal, continuation, or reestablishment - legislative3
declaration - repeal. (29) (a) The following agencies, functions, or both,4
are scheduled for repeal on September 1, 2028:5
(XV) The registration of direct-entry LICENSURE OF CERTIFIED6
PROFESSIONAL midwives by the division of professions and occupations7
in accordance with article 225 of title 12;8
SECTION 29. In Colorado Revised Statutes, 25-2-112, amend9
(7)(b) as follows:10
25-2-112. Certificates of birth - filing - establishment of11
parentage - notice to collegeinvest. (7) The state registrar shall revise12
the birth certificate worksheet form used for the preparation of a13
certificate of live birth to include:14
(b) A requirement to report whether the live birth occurred after15
a transfer to a hospital by a direct-entry midwife registered CERTIFIED16
PROFESSIONAL MIDWIFE LICENSED pursuant to article 225 of title 12; and17
SECTION 30. In Colorado Revised Statutes, 25-1-802, amend18
(1)(a) and (1)(b)(II) as follows:19
25-1-802. Patient records in custody of individual health-care20
providers. (1) (a) Every patient record in the custody of a podiatrist,21
chiropractor, dentist, doctor of medicine, doctor of osteopathy, nurse,22
certified midwife, optometrist, occupational therapist, audiologist,23
acupuncturist, direct-entry CERTIFIED PROFESSIONAL midwife, or physical24
therapist required to be licensed under title 12; a naturopathic doctor25
required to be registered pursuant to article 250 of title 12; or a person26
practicing psychotherapy under article 245 of title 12, except records27
HB24-1262
-39- withheld in accordance with 45 CFR 164.524 (a), must be available to the1
patient or the patient's personal representative upon submission of a valid2
authorization for inspection of records, dated and signed by the patient,3
at reasonable times and upon reasonable notice. A summary of records4
pertaining to a patient's mental health problems may, upon written request5
accompanied by a signed and dated authorization, be made available to6
the patient or the patient's personal representative following termination7
of the treatment program.8
(b) (II) If a licensed health-care professional determines that a9
copy of a radiographic study, including an X ray, mammogram, CT scan,10
MRI, or other film, is not sufficient for diagnostic or other treatment11
purposes, the podiatrist, chiropractor, dentist, doctor of medicine, doctor12
of osteopathy, nurse, certified midwife, optometrist, audiologist,13
acupuncturist, direct-entry CERTIFIED PROFESSIONAL midwife, or physical14
therapist required to be licensed under title 12, or, subject to the15
provisions of section 25-1-801 (1)(a) and subsection (1)(a) of this section,16
the person practicing psychotherapy under article 245 of title 12, shall17
make the original of any radiographic study available to the patient, the18
patient's personal representative, a person authorized by the patient, or19
another health-care professional or facility as specifically directed by the20
patient, personal representative, authorized person, or health-care21
professional or facility pursuant to a HIPAA-compliant authorization and22
upon the payment of the reasonable fees for the radiographic study. If a23
practitioner releases an original radiographic study pursuant to this24
subsection (1)(b)(II), the practitioner is not responsible for any loss,25
damage, or other consequences as a result of the release. Any original26
radiographic study made available pursuant to this subsection (1)(b)(II)27
HB24-1262
-40- must be returned upon request to the lending practitioner within thirty1
days.2
SECTION 31. In Colorado Revised Statutes, 25-3-130, amend3
(6)(c)(III) and (6)(c)(IV) as follows:4
25-3-130. Intimate examination of sedated or unconscious5
patient - informed consent required - rules - definitions. (6) As used6
in this section:7
(c) "Licensed health-care provider" means:8
(III) An advanced practice registered nurse, as defined in section9
12-255-104 (1); a registered nurse, as defined in section 12-255-104 (11);10
or a midwife, other than a direct-entry CERTIFIED PROFESSIONAL midwife11
or certified nurse midwife, practicing in this state whose scope of practice12
includes performing intimate examinations; or13
(IV) A direct-entry midwife registered CERTIFIED PROFESSIONAL14
MIDWIFE LICENSED pursuant to article 225 of title 12.15
SECTION 32. Safety clause. The general assembly finds,16
determines, and declares that this act is necessary for the immediate17
preservation of the public peace, health, or safety or for appropriations for18
the support and maintenance of the departments of the state and state19
institutions.20
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