Second Regular Session
Seventy-fourth General Assembly
STATE OF COLORADO
ENGROSSED
This Version Includes All Amendments Adopted
on Second Reading in the House of Introduction
LLS NO. 24-0285.01 Yelana Love x2295
HOUSE BILL 24-1262
House Committees Senate Committees
Health & Human Services
Appropriations
A BILL FOR AN ACT
C
ONCERNING MATERNAL
HEALTH, AND, IN CONNECTION THEREWITH,101
MAKING AN APPROPRIATION .102
Bill Summary
(Note: This summary applies to this bill as introduced and does
not reflect any amendments that may be subsequently adopted. If this bill
passes third reading in the house of introduction, a bill summary that
applies to the reengrossed version of this bill will be available at
http://leg.colorado.gov
.)
Current law requires "direct-entry midwives" to register with the
division of professions and occupations in the department of regulatory
agencies before practicing. Sections 2 through 12 of the bill make
changes within the direct-entry midwives practice act to update the title
of these professionals to "certified professional midwives" and change the
regulation from registration to licensure. Sections 21 through 31 make
HOUSE
Amended 2nd Reading
April 16, 2024
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. the same updates to current law in other statutes outside of the practice
act.
Current law allows the state board for community colleges and
occupational education to use unexpended resources from the in-demand
short-term health-care credentials program (program) to expand the
eligible programs that may receive support through the program. Section
13 allows the board to expand the eligible programs to include certified
professional midwives.
Section 14 requires the civil rights commission to establish certain
parameters when receiving reports for maternity care. Section 15 adds
pregnancy as a protected class for purposes of discrimination in places of
public accommodation.
The bill adds a midwife to the environmental justice advisory
board (section 16) and the governor's expert emergency epidemic
response committee (section 20).
Section 17 requires a health facility that provides maternal health
services to notify certain individuals before eliminating or reducing the
services.
Section 18 adds midwifery as a preferred area of expertise for
members of the health equity commission.
Section 19 requires the maternal mortality review committee to:
! Study closures related to perinatal health-care practices and
facilities and perinatal health-care deserts and assets related
to perinatal health and health-care services across the state,
not limited to obstetric providers;
! Identify major outcome categories that the department of
public health and environment should track over time and
identify risks and opportunities;
! Explore the effects of practice and facility closures
(closures) on maternal and infant health outcomes and
experiences;
! Identify recommendations during closures and resultant
transfers of care;
! Identify best practice guidelines during closures and
resultant transfers of care; and
! Create a maternal health desert and asset map.
Be it enacted by the General Assembly of the State of Colorado:1
SECTION 1. Legislative declaration. (1) The general assembly2
finds and declares that:3
(a) With the increased demand for reproductive health-care4
1262-2- services in the state, it is important to support the full infrastructure of1
reproductive health-care providers. This includes:2
(I) Integrating the services and expertise of certified professional3
midwives;4
(II) Assessing and maintaining the level of reproductive5
health-care services needed in a community in a way that is accessible to6
the community;7
(III) Understanding the assets and the gaps in services at the8
county level; and9
(IV) Understanding and implementing best practices for when10
services are discontinued in a community, including providing notice11
and a transition plan to the state in order to recognize and monitor the12
ongoing impact to the community.13
(b) Demand for community birth options jumped 30% from 201914
to 2020, with the majority of demand coming from Black and Latinx15
birthing people;16
(c) People are choosing community birth care because they find17
it supportive of not just their health needs but their social, spiritual, and18
community values and needs; however, community birth facilities and19
providers face barriers to providing care; 20
(d) The term "direct-entry midwife" has inconsistent meaning21
across states and causes confusion, whereas "Certified Professional22
Midwife" (CPM) more clearly communicates what these providers do in23
Colorado, and "Certified Professional Midwife" is consistent with the24
nationally recognized credential for midwives specializing in community25
birth. Colorado statutes should be updated to be consistent with other26
states and the national language.27
1262
-3- (e) While not reflected in statute, CPM is the credential that1
direct-entry midwives have been required to have to practice in Colorado,2
as the director of the division of professions and occupations started3
accepting only this credential as proof of satisfying the educational4
requirements listed in statute;5
(f) Over 95% of the direct-entry midwives actively practicing in6
the state hold the CPM credential, and those who don't have decades of7
experience;8
(g) CPMs are considered licensed in other states, including in the9
surrounding states of Wyoming, New Mexico, Utah, and Arizona.10
Colorado statutes should be updated to reflect our alignment with national11
trends and neighboring states.12
(h) Patients should have the ability to choose the provider that is13
right for them, regardless of the setting. Especially for underserved Black,14
Indigenous, Asian, rural, refugee, or immigrant communities or someone15
dealing with a substance use or mental health condition, the ability to16
choose a provider that can meet their needs isn't just important, it could17
be lifesaving.18
(i) Facility and practice closures leave communities scrambling19
when they close suddenly and without guidance to patients. When20
closures occur, the state must ensure that vulnerable communities are21
protected.22
(j) The preventable maternal mortality crisis is only growing23
worse in our state, disproportionately harming Black and Indigenous24
people; and25
(k) The maternal mortality review committee has made several26
recommendations to combat this crisis, including:27
1262
-4- (I) Increased access to a variety of health-care professionals, such1
as CPMs;2
(II) Addressing critical maternal health workforce shortages, such3
as ensuring that CPMs can provide care at their full scope and preventing4
perinatal facility and practice closures as much as possible;5
(III) Examining unintended consequences of policies and6
procedures, such as exploring the impact of facility and practice closures7
on Black, Indigenous, Latinx, Asian, rural, and immigrant and refugee8
communities; and9
(IV) The Colorado department of public health and environment10
recommends that health-care providers be trained and prepared to provide11
a type of care that CPMs already specialize in. The midwifery model of12
care exemplifies certain recommendations such as dyad care,13
trauma-informed care, shared decision-making, and expertise in safe14
transitions, care navigation, and wraparound services.15
SECTION 2. In Colorado Revised Statutes, 12-225-101, amend16
(1)(a), (1)(b), and (2) introductory portion as follows:17
12-225-101. Scope of article - exemptions - legislative18
declaration. (1) (a) This article 225 applies only to direct-entry19
CERTIFIED PROFESSIONAL midwives and does not apply to those persons20
who are otherwise licensed by the state of Colorado under this title 12 if21
the practice of midwifery is within the scope of that licensure.22
(b) (I) A person who is a certified nurse midwife authorized23
pursuant to section 12-255-111, a certified midwife authorized pursuant24
to section 12-255-111.5, or a physician as provided in article 240 of this25
title 12 shall not simultaneously be so licensed and also be registered26
LICENSED under this article 225. A physician, certified nurse midwife, or27
1262
-5- certified midwife who holds a license in good standing may relinquish the1
license and subsequently be registered LICENSED under this article 225. 2
(II) A direct-entry CERTIFIED PROFESSIONAL midwife shall not3
represent oneself as a nurse midwife, certified nurse midwife, or certified4
midwife.5
(III) The fact that a direct-entry CERTIFIED PROFESSIONAL midwife6
may hold a practical or professional nursing license does not expand the7
scope of practice of the direct-entry CERTIFIED PROFESSIONAL midwife.8
(IV) The fact that a practical or professional nurse may be9
registered LICENSED as a direct-entry CERTIFIED PROFESSIONAL midwife10
does not expand the scope of practice of the nurse.11
(2) Nothing in this article 225 shall be construed to prohibit, or to12
require registration LICENSURE under this article 225, with regard to:13
SECTION 3. In Colorado Revised Statutes, amend 12-225-10314
as follows:15
12-225-103. Definitions. As used in this article 225, unless the16
context otherwise requires:17
(1) "Birth center" means a freestanding facility licensed by the18
department of public health and environment that:19
(a) Is not a hospital, attached to a hospital, or located in a hospital;20
(b) Provides prenatal, labor, delivery, and postpartum care to21
low-risk pregnant persons and newborns; and22
(c) Provides care during delivery and immediately after delivery23
that is generally less than twenty-four hours in duration.24
(2) "C
ERTIFIED PROFESSIONAL MIDWIFE" MEANS A PERSON WHO25
PRACTICES CERTIFIED PROFESSIONAL MIDWIFERY .26
(3) "C
ERTIFIED PROFESSIONAL MIDWIFE CREDENTIAL " MEANS A27
1262
-6- CERTIFIED PROFESSIONAL MIDWIFE CREDENTIAL ISSUED BY THE NORTH1
A
MERICAN REGISTRY OF MIDWIVES, OR ITS SUCCESSOR ORGANIZATION.2
(4) "C
ERTIFIED PROFESSIONAL MIDWIFERY " OR "PRACTICE OF3
CERTIFIED PROFESSIONAL MIDWIFERY " MEANS ADVISING, ATTENDING, OR4
ASSISTING AN INDIVIDUAL DURING PREGNANCY , LABOR AND NATURAL5
CHILDBIRTH AT HOME OR AT A BIRTH CENTER , AND THE POSTPARTUM6
PERIOD IN ACCORDANCE WITH THIS ARTICLE 225.7
(1.5)
(5) "Client" means a pregnant woman for whom a8
direct-entry midwife CERTIFIED PROFESSIONAL MIDWIFE performs9
services. For purposes of perinatal or postpartum care, "client" includes10
the woman's newborn.11
(2) "Direct-entry midwife" means a person who practices12
direct-entry midwifery.13
(3) "Direct-entry midwifery" or "practice of direct-entry14
midwifery" means the advising, attending, or assisting of a woman during15
pregnancy, labor and natural childbirth at home or at a birth center, and16
the postpartum period in accordance with this article 225.17
(4) (6) "Natural childbirth" means the birth of a child without the18
use of instruments, surgical procedures, or prescription drugs other than19
those for which the direct-entry CERTIFIED PROFESSIONAL midwife has20
specific authority under this article 225 to obtain and administer.21
(5) (7) "Perinatal" means the period from the twenty-eighth week22
of pregnancy through seven days after birth.23
(6) (8) "Postpartum period" means the period of six weeks after24
birth.25
SECTION 4. In Colorado Revised Statutes, 12-225-104, amend26
(1), (3), (4) introductory portion, (4)(f), (5), and (6); and add (1.5), (1.7),27
1262
-7- and (5.5) as follows:1
12-225-104. Requirement for licensure by the division - annual2
fee - renewal - grounds for revocation - repeal. (1) (a) P
RIOR TO3
S
EPTEMBER 1, 2024, every direct-entry midwife shall register with the4
division by applying to the director in the form and manner the director5
requires. The application shall include the information specified in6
section 12-225-105.7
(b) T
HIS SUBSECTION (1) IS REPEALED, EFFECTIVE SEPTEMBER 1,8
2025.9
(1.5) O
N OR AFTER SEPTEMBER 1, 2024, EXCEPT AS OTHERWISE10
PROVIDED IN THIS ARTICLE 225, AN INDIVIDUAL IN THIS STATE WHO11
PRACTICES CERTIFIED PROFESSIONAL MIDWIFERY OR WHO REPRESENTS12
ONESELF AS BEING ABLE TO PRACTICE CERTIFIED PROFESSIONAL13
MIDWIFERY MUST POSSESS A VALID LICENSE ISSUED BY THE DIRECTOR14
PURSUANT TO THIS ARTICLE 225 AND RULES PROMULGATED PURSUANT TO15
THIS ARTICLE 225.16
(1.7) (a) O
N SEPTEMBER 1, 2024, EACH ACTIVE DIRECT-ENTRY17
MIDWIFE REGISTRATION BECOMES AN ACTIVE CERTIFIED PROFESSIONAL18
MIDWIFE LICENSE BY OPERATION OF LAW . THE CONVERSION FROM19
REGISTRATION TO LICENSURE AND DIRECT -ENTRY MIDWIFE TO CERTIFIED20
PROFESSIONAL MIDWIFE DOES NOT AFFECT ANY PRIOR DISCIPLINE ,21
LIMITATION, OR CONDITION IMPOSED BY THE DIRECTOR ON A22
DIRECT-ENTRY MIDWIFE'S REGISTRATION; LIMIT THE DIRECTOR 'S23
AUTHORITY OVER ANY REGISTRANT ; OR AFFECT ANY PENDING24
INVESTIGATION OR ADMINISTRATIVE PROCEEDING . THE DIRECTOR SHALL25
TREAT ANY APPLICATION FOR A DIRECT -ENTRY MIDWIFE REGISTRATION26
PENDING AS OF AUGUST 31, 2024, INCLUDING ANY APPLICATION FOR27
1262
-8- RENEWAL OR REINSTATEMENT OF A DIRECT -ENTRY MIDWIFE1
REGISTRATION, AS AN APPLICATION FOR A CERTIFIED PROFESSIONAL2
MIDWIFE LICENSE, WHICH APPLICATION IS SUBJECT TO THE REQUIREMENTS3
ESTABLISHED BY THE DIRECTOR.4
(b) T
HIS SUBSECTION (1.7) IS REPEALED, EFFECTIVE SEPTEMBER 1,5
2026.6
(3) Every applicant for registration
LICENSURE shall pay a7
registration LICENSURE fee to be established by the director in the manner8
authorized by section 12-20-105. Registrations LICENSES issued pursuant9
to this article 225 are subject to the renewal, expiration, reinstatement,10
and delinquency fee provisions specified in section 12-20-202 (1) and (2).11
Any person whose registration LICENSE has expired shall be IS subject to12
the penalties provided in this article 225 or section 12-20-202 (1).13
(4) To qualify to register FOR LICENSURE, a direct-entry CERTIFIED14
PROFESSIONAL midwife must have successfully completed an examination15
evaluated and approved by the director as an appropriate test to measure16
competency in the practice of direct-entry CERTIFIED PROFESSIONAL17
midwifery, which examination must have been developed by a person AN18
INDIVIDUAL or entity other than the director or the division and the19
acquisition of which shall require no expenditure of state funds. The20
national registry examination administered by the Midwives Alliance of21
North America NORTH AMERICAN REGISTRY OF MIDWIVES, or its22
successor, must be among those evaluated by the director. The director is23
authorized to approve any existing test meeting all the criteria set forth in24
this subsection (4). In addition to successfully completing the25
examination, a direct-entry CERTIFIED PROFESSIONAL midwife is qualified26
to register FOR LICENSURE if the person INDIVIDUAL has:27
1262
-9- (f) Filed documentation with the director that the direct-entry1
CERTIFIED PROFESSIONAL midwife is currently certified by the American2
Heart Association or the American Red Cross to perform adult and infant3
cardiopulmonary resuscitation ("CPR").4
(5) Effective July 1, 2003, in order to be deemed qualified to5
register, a direct-entry IN ORDER TO OBTAIN A LICENSE , A CERTIFIED6
PROFESSIONAL midwife must have graduated from an accredited7
midwifery educational program;
OBTAINED A CERTIFIED PROFESSIONAL8
MIDWIFE CREDENTIAL FROM THE NORTH AMERICAN REGISTRY OF9
M
IDWIVES, OR ITS SUCCESSOR ORGANIZATION; or obtained a substantially10
equivalent education approved by the director. The educational11
requirement does not apply to
AN INDIVIDUAL INITIALLY REGISTERED AS12
A direct-entry midwives who have registered with the division
MIDWIFE13
before July 1, 2003.14
(5.5) T
HE DIRECTOR SHALL NOT RENEW A CERTIFIED PROFESSIONAL15
MIDWIFE'S LICENSE WITHOUT PROOF THAT THE INDIVIDUAL HAS AN ACTIVE16
CERTIFIED PROFESSIONAL MIDWIFE CREDENTIAL FROM THE NORTH17
A
MERICAN REGISTRY OF MIDWIVES, OR ITS SUCCESSOR ORGANIZATION.18
(6) For purposes of registration
LICENSURE under this article 225,19
no credential, licensure, or certification issued by any other state meets20
the requirements of this article 225, and therefore there is no reciprocity21
with other states.22
SECTION 5. In Colorado Revised Statutes, 12-225-105, amend23
(1) introductory portion, (1)(a), (1)(b), (1)(c), (1)(d), (1)(e), (1)(g), and24
(1)(h) as follows:25
12-225-105. Mandatory disclosure of information to clients.26
(1) Every direct-entry CERTIFIED PROFESSIONAL midwife shall provide27
1262
-10- the following information in writing to each client during the initial client1
contact:2
(a) The name, business address, and business phone number of the3
direct-entry CERTIFIED PROFESSIONAL midwife;4
(b) A listing of the direct-entry CERTIFIED PROFESSIONAL5
midwife's education, experience, degrees, membership in any professional6
organization whose membership includes not less than one-third of all7
registrants LICENSEES, certificates or credentials related to direct-entry8
CERTIFIED PROFESSIONAL midwifery awarded by any such organization,9
and the length of time and number of contact hours required to obtain the10
degrees, certificates, or credentials;11
(c) A statement indicating whether or not the direct-entry12
CERTIFIED PROFESSIONAL midwife is covered under a policy of liability13
insurance for the practice of direct-entry CERTIFIED PROFESSIONAL14
midwifery;15
(d) A listing of any license, certificate, or registration in the16
health-care field previously or currently held by the direct-entry17
CERTIFIED PROFESSIONAL midwife and suspended or revoked by any local,18
state, or national health-care agency;19
(e) A statement that the practice of direct-entry CERTIFIED20
PROFESSIONAL midwifery is regulated by the department. The statement21
must provide the address and telephone number of the office of22
midwifery registration LICENSURE in the division and shall state that23
violation of this article 225 may result in revocation of registration24
LICENSURE and of the authority to practice direct-entry CERTIFIED25
PROFESSIONAL midwifery in Colorado.26
(g) A statement indicating whether or not the direct-entry27
1262
-11- CERTIFIED PROFESSIONAL midwife will administer vitamin K to the1
client's newborn infant and, if not, a list of qualified health-care2
practitioners who can provide that service; and3
(h) A statement indicating whether or not the direct-entry4
CERTIFIED PROFESSIONAL midwife will administer Rho(D) immune5
globulin to the client if she THE CLIENT is determined to be Rh-negative6
and, if not, a list of qualified health-care practitioners who can provide7
that service.8
SECTION 6. In Colorado Revised Statutes, 12-225-106, amend9
(1), (2), (3), (4), (5)(a) introductory portion, (5)(a)(I), (5)(a)(II), (5)(a)(III)10
introductory portion, (5)(a)(III)(A), (5)(a)(III)(C), (5)(a)(III)(E),11
(5)(a)(III)(F), (5)(a)(IV), (6), (7), (8), (9), (10), (11), (13), and (14) as12
follows:13
12-225-106. Prohibited acts - practice standards - informed14
consent - emergency plan - risk assessment - referral - rules. (1) A15
direct-entry CERTIFIED PROFESSIONAL midwife shall not dispense or16
administer any medication or drugs except in accordance with section17
12-225-107.18
(2) A direct-entry CERTIFIED PROFESSIONAL midwife shall not19
perform any operative or surgical procedure; except that a direct-entry20
CERTIFIED PROFESSIONAL midwife may perform sutures of perineal tears21
in accordance with section 12-225-107.22
(3) A direct-entry CERTIFIED PROFESSIONAL midwife shall not23
provide care to a pregnant woman who, according to generally accepted24
medical standards, exhibits signs or symptoms of increased risk of25
medical or obstetric or neonatal complications or problems during the26
completion of her pregnancy, labor, delivery, or the postpartum period.27
1262
-12- Those conditions include but are not limited to signs or symptoms of1
diabetes, multiple gestation, hypertensive disorder, or abnormal2
presentation of the fetus.3
(4) A direct-entry CERTIFIED PROFESSIONAL midwife shall not4
provide care to a pregnant woman who, according to generally accepted5
medical standards, exhibits signs or symptoms of increased risk that her6
child may develop complications or problems during the first six weeks7
of life.8
(5) (a) A direct-entry CERTIFIED PROFESSIONAL midwife shall keep9
appropriate records of midwifery-related activity, including but not10
limited to the following:11
(I) The direct-entry CERTIFIED PROFESSIONAL midwife shall12
complete and file a birth certificate for every delivery in accordance with13
section 25-2-112.14
(II) The direct-entry CERTIFIED PROFESSIONAL midwife shall15
complete and maintain appropriate client records for every client.16
(III) Before accepting a client for care, the direct-entry CERTIFIED17
PROFESSIONAL midwife shall obtain the client's informed consent, which18
shall be evidenced by a written statement in a form prescribed by the19
director and signed by both the direct-entry CERTIFIED PROFESSIONAL20
midwife and the client. The form shall MUST certify that full disclosure21
has been made and acknowledged by the client as to each of the following22
items, with the client's acknowledgment evidenced by a separate signature23
or initials adjacent to each item in addition to the client's signature at the24
end of the form:25
(A) The direct-entry CERTIFIED PROFESSIONAL midwife's26
educational background and training;27
1262
-13- (C) A description of the available alternatives to direct-entry1
CERTIFIED PROFESSIONAL midwifery care, including a statement that the2
client understands the client is not retaining a certified nurse midwife, a3
nurse midwife, or a certified midwife;4
(E) A statement indicating whether or not the direct-entry5
CERTIFIED PROFESSIONAL midwife is covered under a policy of liability6
insurance for the practice of direct-entry CERTIFIED PROFESSIONAL7
midwifery; and8
(F) A statement informing the client that, if subsequent care is9
required resulting from the acts or omissions of the direct-entry CERTIFIED10
PROFESSIONAL midwife, any physician, nurse, certified midwife,11
prehospital emergency personnel, and health-care institution rendering12
subsequent care will be held only to a standard of gross negligence or13
willful and wanton conduct MISCONDUCT;14
(IV) (A) Until the liability insurance required pursuant to section15
12-225-112 (2) is available, each direct-entry CERTIFIED PROFESSIONAL16
midwife shall, before accepting a client for care, provide the client with17
a disclosure statement indicating that the direct-entry CERTIFIED18
PROFESSIONAL midwife does not have liability insurance. To comply with19
this section, the direct-entry CERTIFIED PROFESSIONAL midwife shall20
ensure that the disclosure statement is printed in at least twelve-point21
bold-faced type and shall read the statement to the client in a language the22
client understands. Each client shall sign the disclosure statement23
acknowledging that the client understands the effect of its provisions. The24
direct-entry CERTIFIED PROFESSIONAL midwife shall also sign the25
disclosure statement and provide a copy of the signed disclosure26
statement to the client.27
1262
-14- (B) In addition to the information required in subsection1
(5)(a)(IV)(A) of this section, the direct-entry CERTIFIED PROFESSIONAL2
midwife shall include the following statement in the disclosure statement3
and shall display the statement prominently and deliver the statement4
orally to the client before the client signs the disclosure statement:5
"Signing this disclosure statement does not constitute a waiver of any6
right (insert client's name) has to seek damages or redress from the7
undersigned direct-entry CERTIFIED PROFESSIONAL midwife for any act of8
negligence or any injury (insert client's name) may sustain in the course9
of care administered by the undersigned direct-entry CERTIFIED10
PROFESSIONAL midwife."11
(6) A direct-entry CERTIFIED PROFESSIONAL midwife shall prepare12
a plan, in the form and manner required by the director, for emergency13
situations. The plan must include procedures to be followed in situations14
in which the time required for transportation to the nearest facility15
capable of providing appropriate treatment exceeds limits established by16
the director by rule. A copy of the plan shall be given to each client as17
part of the informed consent required by subsection (5) of this section.18
(7) A direct-entry CERTIFIED PROFESSIONAL midwife shall prepare19
and transmit appropriate specimens for newborn screening in accordance20
with section 25-4-1004 and shall refer every newborn child for21
evaluation, within seven days after birth, to a licensed health-care22
provider with expertise in pediatric care.23
(8) A direct-entry CERTIFIED PROFESSIONAL midwife shall ensure24
that appropriate laboratory testing, as determined by the director, is25
completed for each client.26
(9) (a) A direct-entry CERTIFIED PROFESSIONAL midwife shall27
1262
-15- provide eye prophylactic therapy to all newborn children in the1
direct-entry CERTIFIED PROFESSIONAL midwife's care in accordance with2
section 25-4-301.3
(b) A direct-entry CERTIFIED PROFESSIONAL midwife shall inform4
the parents of all newborn children in the direct-entry CERTIFIED5
PROFESSIONAL midwife's care of the importance of critical congenital6
heart defect screening using pulse oximetry in accordance with section7
25-4-1004.3. If a direct-entry CERTIFIED PROFESSIONAL midwife is not8
properly trained in the use of pulse oximetry or does not have the use of9
or own a pulse oximeter, the direct-entry CERTIFIED PROFESSIONAL10
midwife shall refer the parents to a health-care provider who can perform11
the screening. If a direct-entry CERTIFIED PROFESSIONAL midwife is12
properly trained in the use of pulse oximetry and has the use of or owns13
a pulse oximeter, the direct-entry CERTIFIED PROFESSIONAL midwife shall14
perform the critical congenital heart defect screening on newborn children15
in the direct-entry CERTIFIED PROFESSIONAL midwife's care in accordance16
with section 25-4-1004.3.17
(10) A direct-entry CERTIFIED PROFESSIONAL midwife shall be18
knowledgeable and skilled in aseptic procedures and the use of universal19
precautions and shall use them with every client.20
(11) To assure that proper risk assessment is completed and that21
clients who are inappropriate for direct-entry CERTIFIED PROFESSIONAL22
midwifery are referred to other health-care providers, the director shall23
establish, by rule, a risk assessment procedure to be followed by a24
direct-entry CERTIFIED PROFESSIONAL midwife for each client and25
standards for appropriate referral. The assessment shall be
MADE a part of26
each client's record as required in subsection (5)(a)(II) of this section.27
1262
-16- (13) A registered direct-entry LICENSED CERTIFIED PROFESSIONAL1
midwife may purchase, possess, carry, and administer oxygen. The2
department shall promulgate rules concerning minimum training3
requirements for direct-entry CERTIFIED PROFESSIONAL midwives with4
respect to the safe administration of oxygen. Each registrant LICENSEE5
shall complete the minimum training requirements and submit proof of6
having completed the requirements to the director before administering7
oxygen to any client.8
(14) A registrant LICENSEE shall not practice beyond the scope of9
the registrant's LICENSEE'S education and training.10
SECTION 7. In Colorado Revised Statutes, 12-225-107, amend11
(1), (2) introductory portion, (3), (4), (5), (6), (7), and (8) as follows:12
12-225-107. Limited use of certain medications - emergency13
medical procedures - rules. (1) A registrant LICENSEE may obtain14
prescription medications to treat conditions specified in this section from15
a registered prescription drug outlet, registered manufacturer, or16
registered wholesaler. An entity that provides a prescription medication17
to a registrant LICENSEE in accordance with this section, and who relies18
in good faith upon the registration LICENSE information provided by the19
registrant LICENSEE, is not subject to liability for providing the20
medication.21
(2) Except as otherwise provided in subsection (3) of this section,22
a registrant LICENSEE may obtain and administer:23
(3) (a) If a client refuses a medication listed in subsection (2)(a)24
or (2)(b) of this section, the registrant LICENSEE shall provide the client25
with an informed consent form containing a detailed statement of the26
benefits of the medication and the risks of refusal and shall retain a copy27
1262
-17- of the form acknowledged and signed by the client.1
(b) If a client experiences uncontrollable postpartum hemorrhage2
and refuses treatment with antihemorrhagic drugs, the registrant LICENSEE3
shall immediately initiate the transportation of the client in accordance4
with the emergency plan
REQUIRED BY SECTION 12-225-106 (6).5
(4) A registrant
LICENSEE shall, as part of the emergency medical6
plan required by section 12-225-106 (6), inform the client that:7
(a) If she experiences uncontrollable postpartum hemorrhage, the8
registrant LICENSEE is required by Colorado law to initiate emergency9
medical treatment, which may include the administration of an10
antihemorrhagic drug by the registrant LICENSEE to mitigate the11
postpartum hemorrhaging while initiating the immediate transportation12
of the client in accordance with the emergency plan.13
(b) If she experiences postpartum hemorrhage, the registrant14
LICENSEE is prepared and equipped to administer intravenous fluids to15
restore volume lost due to excessive bleeding.16
(5) The director shall promulgate rules to implement this section.17
In promulgating the rules, the director shall seek the advice of18
knowledgeable medical professionals to set standards for education,19
training, and administration that reflect current generally accepted20
professional standards for the safe and effective use of the medications,21
methods of administration, and procedures described in this section.22
including a requirement that, to administer intravenous fluids, the23
registrant complete an intravenous therapy course or program approved24
by the director. The director shall establish a preferred drug list that25
displays the medications that a registrant can obtain.26
(6) (a) Subject to subsection (6)(b) of this section, a registrant A27
1262
-18- LICENSEE may perform sutures of first-degree and second-degree perineal1
tears, as defined by the director by rule, on a client and may administer2
local anesthetics to the client in connection with suturing perineal tears.3
(b) In order to perform sutures of first-degree and second-degree4
perineal tears, the registrant shall apply to the director, in the form and5
manner required by the director, and pay any application fee the director6
may impose, for an authorization to perform sutures of first-degree and7
second-degree perineal tears. As part of the application, the registrant8
shall demonstrate to the director that the registrant has received education9
and training approved by the director on suturing of perineal tears within10
the year immediately preceding the date of the application or within such11
other time the director, by rule, determines to be appropriate. The director12
may grant the authorization to the registrant only if the registrant has13
complied with the education and training requirement specified in this14
subsection (6)(b).15
(7) A registered direct-entry LICENSED CERTIFIED PROFESSIONAL16
midwife who was initially registered
AS A DIRECT-ENTRY MIDWIFE prior17
to January 1, 2000, must apply to the director and pay any applicable fees18
before obtaining or administering group B streptococcus (GBS)19
prophylaxis as part of the registrant's
LICENSEE'S practice of direct-entry20
CERTIFIED PROFESSIONAL midwifery. The director shall verify the21
qualifications of a registrant LICENSEE applying pursuant to this22
subsection (7) before granting the registrant LICENSEE the authority to23
obtain and administer group B streptococcus (GBS) prophylaxis.24
(8) A registrant LICENSEE who is granted authority to act pursuant25
to this section is not required to apply for renewal of the authority or pay26
any renewal fees pertaining to the authority granted in this section.27
1262
-19- SECTION 8. In Colorado Revised Statutes, 12-225-108, amend1
(1)(b), (1)(c), (1)(d), (1)(f), (1)(g), and (1)(h) as follows:2
12-225-108. Director - powers and duties - rules. (1) In3
addition to any other powers and duties conferred on the director by law,4
the director has the following powers and duties:5
(b) To establish the fees for registration LICENSURE and renewal6
of registration LICENSURE in the manner authorized by section 12-20-105;7
(c) To prepare or adopt suitable education standards for applicants8
and to adopt a registration LICENSURE examination;9
(d) To accept applications for registration LICENSURE that meet the10
requirements set forth in this article 225, and to collect the annual11
registration LICENSURE fees authorized by this article 225;12
(f) To summarily suspend a registration LICENSE upon the failure13
of the registrant LICENSEE to comply with any condition of a stipulation14
or order imposed by the director until the registrant LICENSEE complies15
with the condition, unless compliance is beyond the control of the16
registrant LICENSEE;17
(g) To develop policies and protocols, by rule, for direct-entry18
CERTIFIED PROFESSIONAL midwives in training that reflect the19
requirements of the North American Registry of Midwives, or its20
successor organization;21
(h) To order the physical or mental examination of a direct-entry22
CERTIFIED PROFESSIONAL midwife if the director has reasonable cause to23
believe that the direct-entry CERTIFIED PROFESSIONAL midwife is subject24
to a physical or mental disability that renders the direct-entry CERTIFIED25
PROFESSIONAL midwife unable to treat patients with reasonable skill and26
safety or that may endanger a patient's health or safety. The director may27
1262
-20- order a physical or mental examination regardless of whether there is1
injury to a patient.2
SECTION 9. In Colorado Revised Statutes, 12-225-109, amend3
(1), (3)(b), (3)(d), (3)(g), (3)(h), (3)(i), (3)(m), (3)(n)(I), (3)(n)(II), (4),4
(5), (7), and (8) as follows:5
12-225-109. Disciplinary action authorized - grounds for6
discipline - injunctions - rules. (1) If a direct-entry CERTIFIED7
PROFESSIONAL midwife has violated any of the provisions of section8
12-225-104, 12-225-105, 12-225-106, or 12-225-112 (2), the director may9
take disciplinary or other action as authorized by section 12-20-404 or10
seek an injunction against a direct-entry THE CERTIFIED PROFESSIONAL11
midwife in accordance with section 12-20-406 to enjoin the direct-entry12
CERTIFIED PROFESSIONAL midwife from practicing midwifery or13
committing a violation specified in this subsection (1). 14
(3) The director may take disciplinary action as authorized by15
section 12-20-404 (1)(a), (1)(b), or (1)(d) for any of the following acts or16
omissions:17
18
(b) Failing to provide any information required pursuant to, or to19
pay any fee assessed in accordance with, section 12-225-104 or providing20
false, deceptive, or misleading information to the division that the21
direct-entry CERTIFIED PROFESSIONAL midwife knew or should reasonably22
have known was false, deceptive, or misleading;23
24
(d) Failing to comply with an order of the director, including an25
order placing conditions or restrictions on the registrant's LICENSEE'S26
practice;27
1262
-21- 1
(g) Procuring or attempting to procure a registration LICENSE in2
this or any other state or jurisdiction by fraud, deceit, misrepresentation,3
misleading omission, or material misstatement of fact;4
(h) Having had a license or registration to practice direct-entry5
CERTIFIED PROFESSIONAL midwifery or any other health-care profession6
or occupation suspended or revoked in any jurisdiction;7
(i) Violating any law or regulation governing the practice of8
direct-entry CERTIFIED PROFESSIONAL midwifery in another state or9
jurisdiction. A plea of nolo contendere or its equivalent accepted by any10
state agency of another state or jurisdiction may be considered to be the11
same as a finding of violation for purposes of a proceeding under this12
article 225.13
14
(m) Advertising through newspapers, magazines, circulars, direct15
mail, directories, radio, television, website, e-mail, text message, or16
otherwise that the registrant LICENSEE will perform any act prohibited by17
this article 225; or18
(n) (I) Failing to notify the director, as required by section19
12-30-108 (1), of a physical illness, physical condition, or behavioral,20
mental health, or substance use disorder that renders the registrant21
LICENSEE unable, or limits the registrant's LICENSEE'S ability, to practice22
direct-entry CERTIFIED PROFESSIONAL midwifery with reasonable skill and23
safety to the client;24
(II) Failing to act within the limitations created by a physical25
illness, physical condition, or behavioral, mental health, or substance use26
disorder that renders the registrant LICENSEE unable to practice27
1262
-22- direct-entry CERTIFIED PROFESSIONAL midwifery with reasonable skill and1
safety or that may endanger the health or safety of persons under the2
registrant's LICENSEE'S care; or3
4
(4) Any proceeding to deny, suspend, or revoke a registration5
LICENSE or place a registrant LICENSEE on probation shall be conducted6
pursuant to sections 12-20-403, 24-4-104, and 24-4-105. Section7
12-20-408 governs judicial review of any final decision of the director.8
(5) The director may accept as prima facie evidence of9
grounds for disciplinary action any disciplinary action taken against a10
registrant LICENSEE by another jurisdiction if the violation that prompted11
the disciplinary action would be grounds for disciplinary action under this12
article 225.13
(7) The director may issue and send a letter of admonition to a14
registrant LICENSEE under the circumstances specified in and in15
accordance with section 12-20-404 (4).16
(8) The director may send a confidential letter of concern to a17
registrant LICENSEE under the circumstances specified in section18
12-20-404 (5).19
SECTION 10. In Colorado Revised Statutes, amend 12-225-11020
as follows:21
12-225-110. Unauthorized practice - penalties. Any person22
INDIVIDUAL who practices or offers or attempts to practice direct-entry23
CERTIFIED PROFESSIONAL midwifery OR USES THE TITLE "CERTIFIED24
PROFESSIONAL MIDWIFE" without an active registration LICENSE issued25
under this article 225 is subject to penalties pursuant to section 12-20-40726
(1)(a).27
1262
-23- SECTION 11. In Colorado Revised Statutes, amend 12-225-1121
as follows:2
12-225-112. Assumption of risk - no vicarious liability -3
professional liability insurance required. (1) It is the policy of this4
state that registrants LICENSEES are liable for their acts or omissions in the5
performance of the services that they provide, and that no licensed6
physician, nurse, certified midwife, prehospital emergency medical7
personnel, or health-care institution is liable for any act or omission8
resulting from the administration of services by any registrant LICENSEE.9
This subsection (1) does not relieve any physician, nurse, certified10
midwife, prehospital emergency personnel, or health-care institution from11
liability for any willful and wanton act or omission or any act or omission12
constituting gross negligence or under circumstances where a registrant13
LICENSEE has a business or supervised relationship with the physician,14
nurse, certified midwife, prehospital emergency personnel, or health-care15
institution. A physician, nurse, certified midwife, prehospital emergency16
personnel, or health-care institution may provide consultation or17
education to the registrant LICENSEE without establishing a business or18
supervisory relationship and is encouraged to accept referrals from19
registrants LICENSEES pursuant to this article 225.20
(2) If the director finds that liability insurance is available at an21
affordable price, registrants LICENSEES shall be required to carry liability22
insurance.23
SECTION 12. In Colorado Revised Statutes, amend 12-225-11424
as follows:25
12-225-114. Repeal of article - subject to review. This article26
225 is repealed, effective September 1, 2028. Before the repeal, the27
1262
-24- registering of direct-entry LICENSURE OF CERTIFIED PROFESSIONAL1
midwives by the division is scheduled for review in accordance with2
section 24-34-104. DURING THE REVIEW, THE DEPARTMENT SHALL3
ANALYZE THE ECONOMIC IMPACT OF REQUIRING CERTIFIED PROFESSIONAL4
MIDWIVES TO CARRY LIABILITY INSURANCE AND MAKE A5
RECOMMENDATION ACCORDINGLY .6
7
SECTION 13. In Colorado Revised Statutes, 24-34-305, amend8
(1)(k) as follows:9
24-34-305. Powers and duties of commission. (1) The10
commission has the following powers and duties:11
(k) (I) To receive reports from people alleging
MISTREATMENT IN12
THE CONTEXT OF maternity care, INCLUDING CARE that is not organized13
for, and provided to, a person who is pregnant or in the postpartum period14
AS DEFINED IN SECTION 12-225-103, in a manner that is culturally15
congruent; maintains
THAT FAILS TO MAINTAIN the person's dignity,16
privacy, and confidentiality; ensures THAT FAILS TO ENSURE freedom from17
harm and mistreatment; and enables THAT FAILS TO ENABLE informed18
choices and continuous support.19
(II) R
EPORTS SHALL BE COLLECTED IN A WAY TO ENSURE THAT :20
(A) C
ONFIDENTIAL INFORMATION CAN BE DE -IDENTIFIED;21
(B) I
NDIVIDUALS CAN IDENTIFY MISTREATMENT THEY22
EXPERIENCED BASED ON THE FOLLOWING MISTREATMENT INDEX23
CATEGORIES: PHYSICAL ABUSE, SEXUAL ABUSE, VERBAL ABUSE, STIGMA24
AND DISCRIMINATION, FAILURE TO MEET PROFESSIONAL STANDARDS OF25
CARE, OR POOR RAPPORT BETWEEN PATIENTS OR CLIENTS AND PROVIDERS ;26
POOR CONDITIONS AND CONSTRAINTS PRESENTED BY THE HEALTH -CARE27
1262
-25- SYSTEM; AND OBSTETRIC RACISM;1
(C) N
UMBERS OF REPORTS BASED ON
TYPOLOGY CAN BE2
GENERATED AND SHARED WITH THE PUBLIC AND OTHER AGENCIES ;3
(D) A
N INDIVIDUAL MAY IDENTIFY ANY PROTECTED CLASS THE4
INDIVIDUAL MAY BE PART OF AND THAT MAY HAVE FACTORED INTO THE5
INDIVIDUAL'S MISTREATMENT;6
(E) A
N INDIVIDUAL MAY INDICATE WHAT MIGHT HAVE BEEN DONE7
DIFFERENTLY TO IMPROVE THE INDIVIDUAL 'S SITUATION;8
(F) A
N INDIVIDUAL MAY ENTER NARRATIVE INFORMATION IN THE9
INDIVIDUAL'S OWN WORDS; AND10
(G) A
N INDIVIDUAL MAY VOLUNTARILY SHARE THE INDIVIDUAL 'S11
CONTACT INFORMATION AND INDICATE WHETHER THE INDIVI DUAL12
CONSENTS TO BEING CONTACTED BY THE DEPARTMENT OF REGULATORY13
AGENCIES OR THE DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT . 14
(III) T
HE COMMISSION SHALL GENERATE DE -IDENTIFIED15
COMPOSITE INFORMATION BASED ON REPORTS SUBMITTED PURSUANT TO16
THIS SUBSECTION (1)(k). NOTWITHSTANDING SECTION 24-1-136 (11)(a)(I),17
NO LATER THAN JULY 1, 2025, AND NO LATER THAN JULY 1 EVERY THREE18
YEARS THEREAFTER, THE COMMISSION SHALL SHARE THE GENERATED19
DE-IDENTIFIED COMPOSITE INFORMATION WITH :20
(A) T
HE COLORADO MATERNAL MORTALITY REVIEW COMMITTEE21
CREATED IN SECTION 25-52-104 (1);22
(B) T
HE HOUSE OF REPRESENTATIVES HEALTH AND HUMAN23
SERVICES COMMITTEE AND THE SENATE HEALTH AND HUMAN SERVICES24
COMMITTEE, OR THEIR SUCCESSOR COMMITTEES ; AND25
(C) T
HE MATERNITY ADVISORY COMMITTEE DEFINED IN SECTION26
25.5-4-506 (1)(b).27
1262
-26- (IV) REPORTS MAY BE SHARED INTERNALLY WITH STAFF FOR1
STUDY, INVESTIGATION, REPORTS, PUBLICATIONS, OR HEARINGS.2
3
SECTION 14. In Colorado Revised Statutes, 25-1-134, amend4
(2)(c)(IV) as follows:5
25-1-134. Environmental justice - ombudsperson - advisory6
board - grant program - definitions - repeal. (2) Environmental7
justice advisory board. (c) The advisory board consists of the following8
twelve members who, to the extent practicable, must reside in different9
geographic areas of the state, reflect the racial and ethnic diversity of the10
state, and have experience with a range of environmental issues, including11
air pollution, water contamination, and public health impacts:12
(IV) Four voting members appointed by the executive director of13
the department,
AT LEAST ONE OF WHOM MUST BE A MIDWIFE WHO IS14
PRACTICING IN A FREESTANDING BIRTH CENTER , IN A RURAL AREA, OR AS15
A HOME BIRTH PROVIDER.16
SECTION
15. In Colorado Revised Statutes, add 25-3-131 as17
follows:18
25-3-131. Maternal health-care services - discontinuation19
- required notifications - definition. (1) A
T LEAST
NINETY DAYS BEFORE20
A HOSPITAL PROVIDING MATERNAL HEALTH-CARE SERVICES OR A BIRTH21
CENTER MAY DISCONTINUE SUCH SERVICES, THE FACILITY SHALL PROVIDE22
NOTICE TO:23
(a) T
HE
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT24
RESPONSIBLE FOR LICENSING HEALTH FACILITIES PURSUANT TO SECTION25
25-3-101;26
(b) THE PRIMARY CARE OFFICE, CREATED IN SECTION 25-1.5-403;27
1262
-27- (c) THE GOVERNOR;1
(d) A
LL PATIENTS RECEIVING MATERNAL HEALTH -CARE SERVICES2
AT THE FACILITY AS OF THE DATE OF THE NOTICE;3
(e) A
LL HEALTH-CARE PROVIDERS THAT PROVIDE MATERNAL4
HEALTH-CARE SERVICES FOR THE FACILITY AS OF THE DATE OF THE5
NOTICE; AND6
(f) T
HE GENERAL PUBLIC.7
(2) T
HE NOTICE REQUIRED IN SUBSECTION (1) OF THIS SECTION8
MUST INCLUDE:9
(a) A
DESCRIPTION OF THE MATERNAL HEALTH -CARE SERVICES10
BEING
DISCONTINUED;11
(b) T
HE RATE THE MATERNAL HEALTH -CARE SERVICES HAD BEEN12
PROVIDED AT IN THE PREVIOUS YEAR;13
(c) T
HE NUMBER AND TYPE OF HEALTH -CARE PROVIDERS14
IMPACTED;15
(d) T
HE PROPOSED PLAN FOR TRANSITIONING PATIENTS TO NEW16
HEALTH-CARE PROVIDERS; AND17
(e) T
HE PROPOSED PLAN FOR TRANSITIONING THE HEALTH -CARE18
PROVIDERS TO NEW POSITIONS.19
(3) A
S USED IN THIS SECTION , "MATERNAL HEALTH -CARE20
SERVICES" MEANS HEALTH-CARE SERVICES PROVIDED TO AN INDIVIDUAL21
REGARDING CARE RELATED TO THE INDIVIDUAL 'S PREGNANCY,22
CHILDBIRTH, AND POSTPARTUM PERIOD.23
SECTION 16. In Colorado Revised Statutes, 25-4-2206, amend24
(2)(a)(III) introductory portion and (2)(a)(III)(J); and add (2)(a)(III)(J.5)25
as follows:26
25-4-2206. Health equity commission - creation - repeal.27
1262
-28- (2) (a) The commission consists of the following twenty-three members,1
who are as follows:2
(III) The executive director of the department shall appoint ten3
members who represent, to the extent practical, Colorado's diverse ethnic,4
racial, sexual orientation, gender identity, gender expression, disability,5
aging population, socioeconomic, and geographic backgrounds. Each6
person INDIVIDUAL appointed to the commission must have demonstrated7
expertise in at least one, and preferably two, of the following areas: 8
(J) Behavioral health; or9
(J.5) M
IDWIFERY; OR10
SECTION
17. In Colorado Revised Statutes, 25-52-104, amend11
(2)(b)(II); and add (5.5) as follows:12
25-52-104. Colorado maternal mortality review committee -13
creation - members - duties - report to the general assembly - repeal.14
(2) (b) In appointing members to the committee, the executive director15
shall:16
(II) Ensure that committee members represent diverse17
communities and a variety of clinical, forensic, and psychosocial18
specializations and community perspectives,
INCLUDING19
COMMUNITY-BASED MIDWIFERY; and20
(5.5) THE DEPARTMENT MAY CONTRACT WITH AN INDEPENDENT21
THIRD-PARTY EVALUATOR TO:22
(a) STUDY CLOSURES, CONSOLIDATIONS, AND ACQUISITIONS23
RELATED TO PERINATAL HEALTH -CARE PRACTICES AND FACILITIES AND24
PERINATAL STATE-DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREAS ,25
AS DEFINED IN SECTION 25-1.5-402 (11), AND ASSETS AND DEFICITS26
RELATED TO PERINATAL HEALTH AND HEALTH -CARE SERVICES ACROSS THE27
1262
-29- STATE, NOT LIMITED TO OBSTETRIC PROVIDERS;1
(b) IDENTIFY MAJOR OUTCOME CATEGORIES AT THE CLINICAL ,2
FAMILY, COMMUNITY, AND PROVIDER LEVELS THAT THE DEPARTMENT3
SHOULD TRACK OVER TIME AND IDENTIFY RISKS AND OPPORTUNITIES4
RELATED TO CLOSURES, CONSOLIDATIONS, AND ACQUISITIONS OF5
PERINATAL HEALTH-CARE PRACTICES AND FACILITIES;6
(c) EXPLORE THE EFFECTS OF PRACTICE AND FACILITY CLOSURES7
ON MATERNAL AND INFANT HEALTH OUTCOMES AND EXPERIENCES , TO8
ILLUSTRATE STRUCTURAL NEEDS AROUND CLOSURES, WHEN APPLICABLE;9
(d) IDENTIFY RECOMMENDATIONS DURING PRACTICE AND FACILITY10
CLOSURES AND RESULTANT TRANSFERS OF CARE . THE DEPARTMENT OR11
THIRD PARTY EVALUATOR MAY USE BOTH PRIMARY AND SECONDARY DATA12
IN MAKING THE RECOMMENDATIONS . THE DEPARTMENT OR THIRD PARTY13
EVALUATOR SHALL USE THE MAP CREATED PURSUANT TO SUBSECTION14
(5.5)(f) OF THIS SECTION IN DEVELOPING THE RECOMMENDATIONS . THE15
RECOMMENDATIONS MUST :16
(I) INCLUDE SOLUTIONS AT THE FACILITY LEVEL , THE PRACTICE17
LEVEL, THE WORKFORCE LEVEL , THE COMMUNITY LEVEL , AND THE18
PATIENT LEVEL;19
(II) INCLUDE MINIMUM REQUIREMENTS FOR REPORTING ON20
CLOSURES, INCLUDING METRICS ON TIMELINES AND GEOGRAPHIC AREA,21
INCLUDING WHETHER THE TIMELINE CREATED IN SECTION 25-3-131 IS22
APPROPRIATE;23
(III) DEVELOP RECOMMENDATIONS ON PRIMARY AND SECONDARY24
DATA COLLECTION RELATED TO CLOSURES AND RESULTANT TRANSFERS OF25
CARE.26
(e) IDENTIFY BEST PRACTICE GUIDELINES DURING PRACTICE AND27
1262
-30- FACILITY CLOSURES AND RESULTANT TRANSFERS OF CARE . THE THIRD1
PARTY EVALUATOR MAY USE BOTH PRIMARY AND SECONDARY DATA IN2
IDENTIFYING THE BEST PRACTICE GUIDELINES . THE THIRD PARTY3
EVALUATOR SHALL USE THE MAP CREATED PURSUANT TO SUBSECTION4
(5.5)(f) OF THIS SECTION IN DEVELOPING THE GUIDELINES. THE GUIDELINES5
MUST CONSIDER THE FOLLOWING AREAS : RISKS AND OPPORTUNITIES;6
TRANSFERS OF CARE; COMMUNITY NOTICE NEEDS AND OPPORTUNITIES ;7
NOTIFICATION TO THE DEPARTMENT; CLOSURE TIMELINE; AND RESOURCES8
NEEDED BY FACILITIES, PROVIDERS, AND FAMILIES.9
(f) CREATE A HEALTH PROFESSIONAL SHORTAGE AREA AND10
PERINATAL HEALTH SERVICES ASSETS AND DEFICITS ASSET MAP THAT11
IDENTIFIES BY PERINATAL SERVICE AREA:12
(I) PRIMARY HEALTH-CARE PROVIDERS, INCLUDING PHYSICIANS13
AND MIDWIVES OF ALL CREDENTIAL TYPES WHO PROVIDE OR COULD BE14
PROVIDING PERINATAL HEALTH CARE ;15
(II) THE TYPE AND LOCATION OF PERINATAL HEALTH CARE16
OFFERED BY THE PROVIDERS LISTED PURSUANT TO SUBSECTION (5.5)(f)(I)17
OF THIS SECTION;18
(III) COMMUNITY-BASED PERINATAL HEALTH -CARE WORKERS,19
SUCH AS DOULAS, CHILDBIRTH EDUCATORS, AND LACTATION SUPPORT20
CONSULTANTS; AND21
(IV) RESOURCES SUCH AS COMMUNITY ADVOCATES , GATHERING22
PLACES, AND EDUCATIONAL HUBS;23
(g) BY JULY 1, 2026, DELIVER THE BEST PRACTICES AND24
RECOMMENDATIONS CREATED PURSUANT TO THIS SUBSECTION (5.5) TO25
THE HOUSE OF REPRESENTATIVES HEALTH AND HUMAN SERVICES26
COMMITTEE AND THE SENATE HEALTH AND HUMAN SERVICES COMMI TTEE ,27
1262
-31- OR THEIR SUCCESSOR COMMITTEES .1
SECTION 18. In Colorado Revised Statutes, 24-33.5-704.5,2
amend (1)(b)(II)(G) and (1)(b)(II)(H); and add (1)(b)(II)(I) as follows:3
24-33.5-704.5. Governor's expert emergency epidemic4
response committee - creation. (1) (b) (II) In addition to the state5
members of the committee, the governor shall appoint to the committee6
an individual from each of the following categories:7
(G) A wildlife disease specialist with the division of wildlife; and8
(H) A pharmacist member of the state board of pharmacy;
AND9
(I) A
MIDWIFE WITH EXPERIENCE IN OUT-OF-HOSPITAL BIRTHS.10
SECTION
19. In Colorado Revised Statutes, 12-20-202, amend11
(3)(e)(X) as follows:12
12-20-202. Licenses, certifications, and registrations - renewal13
- reinstatement - fees - occupational credential portability program14
- temporary authority for military spouses - exceptions for military15
personnel - rules - consideration of criminal convictions or driver's16
history - executive director authority - definitions. (3) Occupational17
credential portability program. (e) Subsections (3)(a) to (3)(d) of this18
section do not apply to the following professions or occupations:19
(X) Direct-entry CERTIFIED PROFESSIONAL midwives, regulated20
pursuant to article 225 of this title 12; or21
SECTION 20. In Colorado Revised Statutes, 12-20-404, amend22
(1)(d)(II)(H) as follows:23
12-20-404. Disciplinary actions - regulator powers -24
disposition of fines - mistreatment of at-risk adult - exceptions -25
definitions. (1) General disciplinary authority. If a regulator26
determines that an applicant, licensee, certificate holder, or registrant has27
1262
-32- committed an act or engaged in conduct that constitutes grounds for1
discipline or unprofessional conduct under a part or article of this title 122
governing the particular profession or occupation, the regulator may:3
(d) (II) A regulator is not authorized under this subsection (1)(d)4
to refuse to renew the license, certification, or registration of a licensee,5
certificate holder, or registrant regulated under the following:6
(H) Article 225 of this title 12 concerning direct-entry CERTIFIED7
PROFESSIONAL midwives;8
SECTION 21. In Colorado Revised Statutes, 12-20-407, amend9
(1)(a)(V)(K) and (1)(e)(V) as follows:10
12-20-407. Unauthorized practice of profession or occupation11
- penalties - exclusions. (1) (a) A person commits a class 2 misdemeanor12
and shall be punished as provided in section 18-1.3-501 if the person:13
(V) Practices or offers or attempts to practice any of the following14
professions or occupations without an active license, certification, or15
registration issued under the part or article of this title 12 governing the16
particular profession or occupation:17
(K) Direct-entry CERTIFIED PROFESSIONAL midwifery, as regulated18
under article 225 of this title 12;19
(e) A person commits a class 6 felony and shall be punished as20
provided in section 18-1.3-401 if the person practices or offers or21
attempts to practice any of the following professions or occupations and22
intentionally and fraudulently represents oneself as a licensed, certified,23
or registered professional or practitioner pursuant to a part or article of24
this title 12 governing the particular profession or occupation:25
(V) Direct-entry CERTIFIED PROFESSIONAL midwifery, as regulated26
pursuant to article 225 of this title 12;27
1262
-33- SECTION 22. In Colorado Revised Statutes, 12-20-408, amend1
(1)(c) as follows:2
12-20-408. Judicial review. (1) Except as specified in subsection3
(2) of this section, the court of appeals has initial jurisdiction to review4
all final actions and orders of a regulator that are subject to judicial5
review and shall conduct the judicial review proceedings in accordance6
with section 24-4-106 (11); except that, with regard only to7
cease-and-desist orders, a district court of competent jurisdiction has8
initial jurisdiction to review a final action or order of a regulator that is9
subject to judicial review and shall conduct the judicial review10
proceedings in accordance with section 24-4-106 (3) for the following:11
(c) Article 225 of this title 12 concerning direct-entry CERTIFIED12
PROFESSIONAL midwives;13
SECTION 23. In Colorado Revised Statutes, 12-30-102, amend14
(3)(a)(X) as follows:15
12-30-102. Medical transparency act of 2010 - disclosure of16
information about health-care providers - fines - rules - short title -17
legislative declaration - review of functions - definition - repeal.18
(3) (a) As used in this section, "applicant" means a person applying for19
a new, active license, certification, or registration or to renew, reinstate,20
or reactivate an active license, certification, or registration to practice:21
(X) Direct-entry CERTIFIED PROFESSIONAL midwifery pursuant to22
article 225 of this title 12;23
SECTION 24. In Colorado Revised Statutes, 12-30-122, amend24
(6)(d)(III) and (6)(d)(IV) as follows:25
12-30-122. Intimate examination of sedated or unconscious26
patient - informed consent required - definitions. (6) As used in this27
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(d) "Licensee" means:2
(III) An advanced practice registered nurse, as defined in section3
12-255-104 (1); a registered nurse, as defined in section 12-255-104 (11);4
or a midwife, other than a direct-entry CERTIFIED PROFESSIONAL midwife5
or certified nurse midwife, practicing in this state whose scope of practice6
includes performing intimate examinations; or7
(IV) A direct-entry CERTIFIED PROFESSIONAL midwife registered8
pursuant to article 225 of this title 12.9
SECTION 25. In Colorado Revised Statutes, 13-21-115.5,10
amend (3)(c)(II)(C) as follows:11
13-21-115.5. Volunteer service act - immunity - exception for12
operation of motor vehicles - short title - legislative declaration -13
definitions. (3) As used in this section, unless the context otherwise14
requires:15
(c) (II) "Volunteer" includes:16
(C) A registered direct-entry LICENSED CERTIFIED PROFESSIONAL17
midwife governed by article 225 of title 12 performing the practice of18
direct-entry CERTIFIED PROFESSIONAL midwifery, as defined in section19
12-225-103 (3) 12-225-103 (4), as a volunteer for a nonprofit20
organization, a nonprofit corporation, a governmental entity, or a hospital;21
SECTION 26. In Colorado Revised Statutes, 24-34-104, amend22
(29)(a)(XV) as follows:23
24-34-104. General assembly review of regulatory agencies24
and functions for repeal, continuation, or reestablishment - legislative25
declaration - repeal. (29) (a) The following agencies, functions, or both,26
are scheduled for repeal on September 1, 2028:27
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PROFESSIONAL midwives by the division of professions and occupations2
in accordance with article 225 of title 12;3
SECTION 27. In Colorado Revised Statutes, 25-2-112, amend4
(7)(b) as follows:5
25-2-112. Certificates of birth - filing - establishment of6
parentage - notice to collegeinvest. (7) The state registrar shall revise7
the birth certificate worksheet form used for the preparation of a8
certificate of live birth to include:9
(b) A requirement to report whether the live birth occurred after10
a transfer to a hospital by a direct-entry midwife registered CERTIFIED11
PROFESSIONAL MIDWIFE LICENSED pursuant to article 225 of title 12; and12
SECTION 28. In Colorado Revised Statutes, 25-1-802, amend13
(1)(a) and (1)(b)(II) as follows:14
25-1-802. Patient records in custody of individual health-care15
providers. (1) (a) Every patient record in the custody of a podiatrist,16
chiropractor, dentist, doctor of medicine, doctor of osteopathy, nurse,17
certified midwife, optometrist, occupational therapist, audiologist,18
acupuncturist, direct-entry CERTIFIED PROFESSIONAL midwife, or physical19
therapist required to be licensed under title 12; a naturopathic doctor20
required to be registered pursuant to article 250 of title 12; or a person21
practicing psychotherapy under article 245 of title 12, except records22
withheld in accordance with 45 CFR 164.524 (a), must be available to the23
patient or the patient's personal representative upon submission of a valid24
authorization for inspection of records, dated and signed by the patient,25
at reasonable times and upon reasonable notice. A summary of records26
pertaining to a patient's mental health problems may, upon written request27
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the patient or the patient's personal representative following termination2
of the treatment program.3
(b) (II) If a licensed health-care professional determines that a4
copy of a radiographic study, including an X ray, mammogram, CT scan,5
MRI, or other film, is not sufficient for diagnostic or other treatment6
purposes, the podiatrist, chiropractor, dentist, doctor of medicine, doctor7
of osteopathy, nurse, certified midwife, optometrist, audiologist,8
acupuncturist, direct-entry CERTIFIED PROFESSIONAL midwife, or physical9
therapist required to be licensed under title 12, or, subject to the10
provisions of section 25-1-801 (1)(a) and subsection (1)(a) of this section,11
the person practicing psychotherapy under article 245 of title 12, shall12
make the original of any radiographic study available to the patient, the13
patient's personal representative, a person authorized by the patient, or14
another health-care professional or facility as specifically directed by the15
patient, personal representative, authorized person, or health-care16
professional or facility pursuant to a HIPAA-compliant authorization and17
upon the payment of the reasonable fees for the radiographic study. If a18
practitioner releases an original radiographic study pursuant to this19
subsection (1)(b)(II), the practitioner is not responsible for any loss,20
damage, or other consequences as a result of the release. Any original21
radiographic study made available pursuant to this subsection (1)(b)(II)22
must be returned upon request to the lending practitioner within thirty23
days.24
SECTION 29. In Colorado Revised Statutes, 25-3-130, amend25
(6)(c)(III) and (6)(c)(IV) as follows:26
25-3-130. Intimate examination of sedated or unconscious27
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in this section:2
(c) "Licensed health-care provider" means:3
(III) An advanced practice registered nurse, as defined in section4
12-255-104 (1); a registered nurse, as defined in section 12-255-104 (11);5
or a midwife, other than a direct-entry CERTIFIED PROFESSIONAL midwife6
or certified nurse midwife, practicing in this state whose scope of practice7
includes performing intimate examinations; or8
(IV) A direct-entry midwife registered CERTIFIED PROFESSIONAL9
MIDWIFE LICENSED pursuant to article 225 of title 12.10
SECTION 30. Appropriation. (1) For the 2024-25 state fiscal11
year, $328,946 is appropriated to the department of public health and12
environment for use by the prevention services division. This13
appropriation is from the general fund. To implement this act, the division14
may use this appropriation for maternal and child health related to15
community health, which amount is based on an assumption that the16
division will require an additional 0.8 FTE.17
(2) For the 2024-25 state fiscal year, $118,771 is appropriated to18
the department of regulatory agencies. This appropriation consists of19
$111,072 from the general fund and $7,699 from the division of20
professions and occupations cash fund created in 12-20-105 (3), C.R.S.21
To implement this act, the department may use this appropriation as22
follows:23
(a) $54,717 from general fund for use by the civil rights division24
for personal services, which amount is based on an assumption that the25
division will require an additional 1.0 FTE;26
(b) $7,950 from general fund for use by the civil rights division27
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(c) $7,669 from the division of professions and occupations cash2
fund for use by the division of professions and occupations, which3
amount is based on an assumption that the division will require an4
additional 0.1 FTE; 5
(d) $32,005 from general fund for the purchase of legal services;6
and7
(e) $16,400 from general fund for the purchase of information8
technology services. 9
(3) For the 2024-25 state fiscal year, $32,005 is appropriated to10
the department of law. This appropriation is from reappropriated funds11
received from the department of regulatory agencies under subsection12
(2)(d) of this section and is based on an assumption that the department13
of law will require an additional 0.1 FTE. To implement this act, the14
department of law may use this appropriation to provide legal services for15
the department of regulatory agencies.16
(4) For the 2024-25 state fiscal year, $16,400 is appropriated to17
the office of the governor for use by the office of information technology.18
This appropriation is from reappropriated funds received from the19
department of regulatory agencies under subsection (2)(e) of this section.20
To implement this act, the office may use this appropriation to provide21
information technology services for the department of regulatory22
agencies.23
SECTION 31. Safety clause. The general assembly finds,24
determines, and declares that this act is necessary for the immediate25
preservation of the public peace, health, or safety or for appropriations for26
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institutions.2
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