Page 1
March 26, 2024 SB 24-175
Legislative Council Staff
Nonpartisan Services for Colorado’s Legislature
Fiscal Note
Drafting Number:
Prime Sponsors:
LLS 24-0137
Sen. Fields; Buckner
Rep. McLachlan
Date:
Bill Status:
Fiscal Analyst:
March 26, 2024
Senate Health & Human Services
Kristine McLaughlin | 303-866-4776
kristine.mclaughlin@coleg.gov
Bill Topic: IMPROVING PERINATAL HEALTH OUTCOMES
Summary of
Fiscal Impact:
☐ State Revenue
☒ State Expenditure
☐ State Transfer
☐ TABOR Refund
☐ Local Government
☐ Statutory Public Entity
The bill creates and modifies multiple programs concerning perinatal health. Starting
in FY 2024-25, the bill increases state expenditures on an ongoing basis.
Appropriation
Summary:
For FY 2024-25, the bill requires appropriations totaling $1,083,052 to multiple state
agencies.
Fiscal Note
Status:
The fiscal note reflects the introduced bill.
Table 1
State Fiscal Impacts Under SB 24-175
Budget Year
FY 2024-25
Out Year
FY 2025-26
Revenue - -
Expenditures General Fund $806,011 $799,341
Federal Funds $277,041 $277,041
Centrally Appropriated $17,018 $17,018
Total Expenditures $1,100,070 $1,093,400
Total FTE 0.9 FTE 0.9 FTE
Transfers - -
Other Budget Impacts General Fund Reserve $120,902 $119,901
Page 2
March 26, 2024 SB 24-175
Summary of Legislation
The bill creates and modifies multiple programs concerning perinatal health, as discussed below.
Doula service coverage. The bill requires large employer health benefit plans to cover doula
services to the same extent and with the same provider qualification requirements as required
by Medicaid. It requires the Department of Regulatory Agencies (DORA) to submit a state
defrayal determination to the federal Department of Health and Human Services for other
state-regulated insurance plans and require coverage upon confirmation or after 365 days if no
response is received.
Maternal and infant health quality improvement initiatives. The bill mandates hospitals that
provide labor and deliver or neonatal care services to participate in at least one maternal or
infant health quality improvement initiative and meet reporting requirements.
Perinatal Health Quality Improvement Engagement Program. The bill requires the
Department of Public Health and Environment (CDPHE), in collaboration with the Perinatal
Quality Collaborative (PQC), to:
create the Perinatal Health Quality Improvement Engagement Program to distribute grants
to select hospitals to meet the mandate;
track implementation of the recommendations of the Colorado Maternal Mortality Review
Committee;
implement their own initiatives to improve maternal mortality and morbidity; and
address discrepancies in care.
Choline supplements. The bill requires the Department of Health Care Policy and Financing to
cover choline supplements.
State Expenditures
The bill increases state expenditures in CDPHE by about $580,000 in FY 2024-25 and $570,000 in
FY 2025-26, paid from the General Fund. The bill increases state expenditures in HCPF by
$524,000 annually paid from the General Fund and federal funds. Expenditures are shown in
Table 2 and detailed below.
Page 3
March 26, 2024 SB 24-175
Table 2
Expenditures Under SB 24-175
FY 2024-25 FY 2025-26
Department of Public Health and Environment
Personal Services $70,830 $70,830
Operating Expenses $1,152 $1,152
Capital Outlay Costs $6,670 -
Grant Program $480,000 $480,000
Centrally Appropriated Costs
1
$17,018 $17,018
FTE – Personal Services 0.9 FTE 0.9 FTE
CDPHE Subtotal $575,670 $569,000
Department of Health Care Policy and Financing
Choline Supplement Coverage $524,400 $524,400
HCPF Subtotal $524,400 $524,400
General Fund
Federal Funds
$247,359
$277,041
$247,359
$277,041
Total $1,100,070 $1,093,400
Total FTE 0.9 FTE 0.9 FTE
1
Centrally appropriated costs are not included in the bill's appropriation.
Department of Public Health and Environment. CDPHE requires staff and contract funds to
operate the grant program, and staff to track implementation of the Colorado Maternal
Mortality Review Committee’s recommendations. The fiscal note assumes that CDPHE’s current
efforts concerning perinatal health outcomes meet the other requirements of the bill.
Grant program. CDPHE requires 0.7 FTE and contract funds to operate the grant program.
The staff will solicit grant applications, select the grant recipients, and provide technical
assistance. The contract funds are subject to available appropriations. Currently, the PQC
assists 36 hospitals in implementing and maintaining initiatives to improve outcomes at a
cost of about $80,000 per hospital. There are an additional 19 hospitals that would be
subject to the mandate to participate in at least one initiative. The fiscal note includes
$480,000 in grant funding, enough to support six additional hospitals.
Implementation tracking and reporting. CDPHE requires 0.2 FTE to meet the reporting
requirements of the bill and assist the PQC in tracking implementation of the
recommendations of the Colorado Maternal Mortality Review Committee by developing
reasonable metrics for tracking purposes. Given this assistance, the fiscal note assumes that
the PQC can absorb the work of tracking the metrics within the grant program contract. Page 4
March 26, 2024 SB 24-175
Department of Health Care Policy and Financing. The bill requires HCPF to cover doula
services for its Children’s Health Plan Plus members (CHP+) and choline supplements for its
Medicaid members. HCPF already covers doula services for all members. The fiscal note assumes
that choline will only be covered when prescribed. Supply may be limited, especially in the first
year, as a result of this restriction, as choline manufactures’ administrative focus is typically on
the over-the-counter market. The fiscal note assumes that all members who take prescription
prenatal vitamins will take choline once covered at a cost of about $50 per pregnancy. The
prescription is assumed to receive a federal match of 52.8 percent.
Department of Regulatory Agencies. DORA may experience an increased workload, as the bill
could result in health insurance carriers filing for a rate adjustment. The fiscal note assumes that
this can be accomplished within existing resources.
State employee insurance. State employee insurance is subject to state regulation and would
be required to comply with the coverage requirement in the bill. Any cost increase could
contribute to higher insurance premiums, which would be shared by state agencies and
employees. Because insurance premiums are influenced by a number of variables and the cost
share between the state and employees has not been determined for future fiscal years, a cost
to the state is not estimated.
Centrally appropriated costs. Pursuant to a Joint Budget Committee policy, certain costs
associated with this bill are addressed through the annual budget process and centrally
appropriated in the Long Bill or supplemental appropriations bills, rather than in this bill. These
costs, which include employee insurance and supplemental employee retirement payments, are
shown in Table 2.
Effective Date
The bill takes effect upon signature of the Governor, or upon becoming law without his signature.
State Appropriations
For FY 2024-25, the bill requires:
a General Fund appropriation of $558,652 to the Department of Public Health and
Environment, and 0.9 FTE; and
an appropriation of $524,400 to the Department of Health Care Policy and Financing, of
which $247,359 is from the General Fund and $277,041 is from federal funds.
State and Local Government Contacts
Behavioral Health Administration Corrections Health Care Policy and Financing
Information Technology Human Services Public Health and Environment
Regulatory Agencies
The revenue and expenditure impacts in this fiscal note represent changes from current law under the bill for each
fiscal year. For additional information about fiscal notes, please visit the General Assembly website.