House Bill 26-1044 Introduced

A Bill for an Act

• Page 1, Line 101Concerning measures to improve equity in maternal health.

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.)

The bill requires measures to improve equity in maternal health, including:

• Requiring a physician, nurse, or nurse aide whose primary practice is in the area of obstetrics to complete at least one continuing education credit hour on the topic of cultural competence and equity in maternal care;
• Authorizing the department of public health and environment (CDPHE), subject to available appropriations, to provide a health survey to all birthing parents and to compile the data;
• Requiring a health facility that provides labor and childbirth services to publicly display in birthing areas a statement on respectful maternity care regarding principles and components, including freedom from harm, privacy, informed consent, and allowing a birthing parent to have a birthing companion present at the birth;
• Requiring that the maternal health task force established by CDPHE includes at least one Black maternal health advocate; and
• Requiring CDPHE to report annually to the general assembly, rather than every 3 years, concerning maternal health outcomes and equity, including outcomes for Black birthing parents and suspected or known causes of any disparate outcomes for Black birthing parents.

In addition, the bill requires a health facility to report to CDPHE incidents of severe maternal morbidity or death of a birthing parent for which there is reasonable cause for the health facility to believe that racial discrimination, implicit or explicit bias, negligent clinical decision-making, denial of care, or other inequitable treatment (discriminatory or negligent misconduct) contributed to the severe maternal morbidity or death. CDPHE is required to investigate such incidents and report to the applicable regulatory board (regulator) if the investigation reveals that a health-care practitioner may have engaged in the discriminatory or negligent misconduct.

In addition to other penalties, the bill authorizes a regulator to impose and collect monetary penalties against a health-care practitioner that is found to have engaged in the discriminatory or negligent misconduct that led to severe maternal morbidity or death.

If a health facility has engaged in discriminatory practices, failed to follow evidence-based standards of obstetric care, or refused to act on known symptoms that resulted in severe maternal morbidity or death, CDPHE may revoke or suspend the health facility's license and impose and collect a monetary penalty of up to $250,000 per violation.

Those monetary penalties are deposited into the maternal health equity improvement fund created in the bill and will be used to provide support to families after preventable severe maternal morbidity or death and for other activities that are intended to reduce adverse maternal health outcomes.

The bill requires CDPHE's office of health equity to report aggregated and de-identified data concerning the incidents of discriminatory or negligent misconduct that resulted in preventable severe maternal morbidity or death.

• Page 3, Line 1Be it enacted by the General Assembly of the State of Colorado:

• Page 3, Line 2SECTION 1.  In Colorado Revised Statutes, 12-240-130.5,

• Page 3, Line 3amend (7) introductory portion; and add (7)(a.5) as follows:

• Page 3, Line 412-240-130.5.  Continuing medical education - requirement -

• Page 3, Line 5compliance - legislative declaration - rules - definitions.

• Page 3, Line 6(7)  The board shall promulgate adopt rules necessary to

• Page 3, Line 7implement a physician CME requirement in accordance with this section.

• Page 3, Line 8In addition to any other rules, the board shall adopt rules:

• Page 3, Line 9(a.5)  Requiring a physician whose primary practice is in the

• Page 3, Line 10area of obstetrics to complete at least one CME credit hour on

• Page 3, Line 11the topic of cultural competence and equity in maternal care.

• Page 3, Line 12For purposes of complying with this subsection (7)(a.5), the board

• Page 3, Line 13may authorize a CME credit hour provided through a program

• Page 3, Line 14that does not meet the requirements to qualify for CME credit

• Page 3, Line 15as set forth in subsection (3)(d) of this section.

• Page 3, Line 16SECTION 2.  In Colorado Revised Statutes, amend 12-255-129

• Page 3, Line 17as follows:

• Page 3, Line 1812-255-129.  Continuing education - rules.

• Page 3, Line 19(1)  In addition to any other authority conferred upon the board by

• Page 3, Line 20this part 1, the board is authorized to require no more than twenty hours

• Page 3, Line 21of continuing education every two years as a condition of renewal of

• Page 3, Line 22licenses and to establish procedures and standards for the educational

• Page 3, Line 23requirements. The board shall, to assure that the continuing education

• Page 3, Line 24requirements imposed do not have the effect of restraining competition

• Page 3, Line 25among providers of the education, recognize a variety of alternative

• Page 3, Line 26means of compliance with the requirements. The board shall adopt rules

• Page 4, Line 1that are necessary to carry out the provisions of this section in accordance

• Page 4, Line 2with article 4 of title 24.

• Page 4, Line 3(2)  The board shall adopt rules requiring a nurse or nurse

• Page 4, Line 4aide whose work requires the nurse or nurse aide to practice

• Page 4, Line 5primarily in the area of obstetrics, including labor and

• Page 4, Line 6childbirth, to complete at least one credit hour of continuing

• Page 4, Line 7education on cultural competence and equity in maternal care.

• Page 4, Line 8SECTION 3.  In Colorado Revised Statutes, 25-1.5-701, add (3)

• Page 4, Line 9as follows:

• Page 4, Line 1025-1.5-701.  Health survey for birthing parents.

• Page 4, Line 11(3)  In addition to the multiyear survey described in

• Page 4, Line 12subsections (1) and (2) of this section, subject to available

• Page 4, Line 13appropriations, the department may implement a standardized,

• Page 4, Line 14anonymous survey of additional or all people in Colorado who

• Page 4, Line 15have recently given birth. The survey may cover health and

• Page 4, Line 16safety topics, as described in subsection (1) of this section, or

• Page 4, Line 17additional topics. The department shall determine the format

• Page 4, Line 18for the survey and may design the survey so that the survey may

• Page 4, Line 19be taken, and results may be compiled, electronically.

• Page 4, Line 20SECTION 4.  In Colorado Revised Statutes, 25-3-126, add (1.5)

• Page 4, Line 21and (2.5) as follows:

• Page 4, Line 2225-3-126.  Health facilities - health-care practitioners -

• Page 4, Line 23requirements related to labor and childbirth - rules - definitions.

• Page 4, Line 24(1.5)  Statement on respectful maternity care.

• Page 4, Line 25(a)  No later than January 1, 2027, a health facility that

• Page 4, Line 26provides labor and childbirth services shall publicly display a

• Page 4, Line 27statement on respectful maternity care in the health facility's

• Page 5, Line 1birthing areas.

• Page 5, Line 2(b) (I)  The department shall create or approve and make

• Page 5, Line 3electronically available a uniform statement on respectful

• Page 5, Line 4maternity care for public display pursuant to subsection (1.5)(a)

• Page 5, Line 5of this section. The department may accept a statement on

• Page 5, Line 6respectful maternity care submitted by an individual,

• Page 5, Line 7organization, or entity that includes the principles and

• Page 5, Line 8components specified in subsection (1.5)(b)(II) of this section.

• Page 5, Line 9(II)  A statement on respectful maternity care must

• Page 5, Line 10include the following principles and components as part of

• Page 5, Line 11labor and childbirth:

• Page 5, Line 12(A)  A birthing parent's freedom from harm and

• Page 5, Line 13mistreatment;

• Page 5, Line 14(B)  Respect for a birthing parent's dignity, privacy, and

• Page 5, Line 15confidentiality;

• Page 5, Line 16(C)  A birthing parent's informed choice and consent;

• Page 5, Line 17(D)  Allowing and encouraging the presence of a birthing

• Page 5, Line 18companion or family member during labor and childbirth;

• Page 5, Line 19(E)  Equitable and high-quality care for a birthing parent

• Page 5, Line 20that is evidence-based, free from discrimination, and culturally

• Page 5, Line 21sensitive; and

• Page 5, Line 22(F)  Effective communication, during which health-care

• Page 5, Line 23practitioners introduce themselves, explain their roles, and

• Page 5, Line 24welcome questions and concerns from a birthing parent.

• Page 5, Line 25(c)  In addition to the components specified in subsection

• Page 5, Line 26(1.5)(b)(II) of this section, the statement on respectful maternity

• Page 5, Line 27care must contain information, including telephone contact

• Page 6, Line 1information, concerning where to file a complaint with the

• Page 6, Line 2appropriate state or federal office or agency relating to the

• Page 6, Line 3birthing process that alleges discrimination based on disability,

• Page 6, Line 4race, creed, color, sex, sexual orientation, gender identity,

• Page 6, Line 5gender expression, marital status, national origin, ancestry, or

• Page 6, Line 6age.

• Page 6, Line 7(d)  At the time of admission, a health facility shall

• Page 6, Line 8provide to a birthing parent any principles or components of the

• Page 6, Line 9statement on respectful maternity care that have not already

• Page 6, Line 10been shared with the birthing parent.

• Page 6, Line 11(e)  The requirements set forth in this subsection (1.5)

• Page 6, Line 12relating to providing and displaying a statement on respectful

• Page 6, Line 13maternity care:

• Page 6, Line 14(I)  Do not apply to labor and childbirth policies described

• Page 6, Line 15in subsection (2) of this section relating to a birthing individual

• Page 6, Line 16who is in custody; and

• Page 6, Line 17(II)  Do not create a private right of action against a

• Page 6, Line 18health facility, a health facility employee, a person with whom

• Page 6, Line 19the health facility has a contractual relationship, or a

• Page 6, Line 20health-care practitioner for failing to comply with this

• Page 6, Line 21subsection (1.5).

• Page 6, Line 22(2.5)  Accountability for discrimination, mistreatment, and

• Page 6, Line 23preventable maternal deaths - health-care practitioners - health

• Page 6, Line 24facilities - penalties - maternal health equity improvement fund.

• Page 6, Line 25(a) (I)  A health facility shall report to the department

• Page 6, Line 26each incident in which:

• Page 6, Line 27(A)   A birthing parent experiences severe maternal

• Page 7, Line 1morbidity or death; and

• Page 7, Line 2(B)  Based on information known by or reported to the

• Page 7, Line 3health facility, there is reasonable cause for the health

• Page 7, Line 4facility to believe that racial discrimination, implicit or explicit

• Page 7, Line 5bias, negligent clinical decision-making, denial of care, or other

• Page 7, Line 6inequitable treatment may have contributed to the birthing

• Page 7, Line 7parent's severe maternal morbidity or death.

• Page 7, Line 8(II)  A health facility must submit a report to the

• Page 7, Line 9department within ten days after the health facility becomes

• Page 7, Line 10aware of the incident described in subsection (2.5)(a)(I) of this

• Page 7, Line 11section.

• Page 7, Line 12(III)  A health facility in which a birthing parent

• Page 7, Line 13experiences severe maternal morbidity or death shall provide,

• Page 7, Line 14to the extent permitted by law:

• Page 7, Line 15(A)  Disclosure of clinical findings;

• Page 7, Line 16(B)  A written explanation of the right to file a complaint

• Page 7, Line 17with the department of public health and environment or the

• Page 7, Line 18Colorado civil rights division in the department of regulatory

• Page 7, Line 19agencies and of the process for filing a complaint;

• Page 7, Line 20(C)  Access to medical or investigatory reports; and

• Page 7, Line 21(D)  Information concerning the outcome of state

• Page 7, Line 22investigations.

• Page 7, Line 23(b) (I)  Upon receiving a report made pursuant to

• Page 7, Line 24subsection (2.5)(a) of this section, the department shall initiate

• Page 7, Line 25an immediate investigation into the clinical, procedural, and

• Page 7, Line 26systemic factors that may have resulted in the birthing parent's

• Page 7, Line 27severe maternal morbidity or death.

• Page 8, Line 1(II)  The investigation required in this subsection (2.5)(b)

• Page 8, Line 2must include:

• Page 8, Line 3(A)  Interviews with the birthing parent, family, and

• Page 8, Line 4birthing companion, as applicable;

• Page 8, Line 5(B)  Review of clinical records, subject to laws pertaining

• Page 8, Line 6to the review of confidential medical records;

• Page 8, Line 7(C)  Interviews with the health-care practitioners

• Page 8, Line 8involved with the birthing parent's care;

• Page 8, Line 9(D)  Evaluation for racial bias or discriminatory

• Page 8, Line 10treatment and implicit or explicit bias; and

• Page 8, Line 11(E)  Assessment of compliance with distribution to the

• Page 8, Line 12birthing parent and posting for public display of the statement

• Page 8, Line 13on respectful maternity care described in subsection (1.5) of this

• Page 8, Line 14section.

• Page 8, Line 15(c)  If the department determines during the course of the

• Page 8, Line 16investigation conducted pursuant to subsection (2.5)(b) of this

• Page 8, Line 17section that a health-care practitioner may have engaged in the

• Page 8, Line 18discriminatory or negligent misconduct described in subsection

• Page 8, Line 19(2.5)(a)(I)(B) of this section that resulted in the birthing parent's

• Page 8, Line 20severe maternal morbidity or death, the department shall refer

• Page 8, Line 21the matter to the regulator for the applicable health-care

• Page 8, Line 22practitioner, including:

• Page 8, Line 23(I)  The Colorado medical board created in section

• Page 8, Line 2412-240-105;

• Page 8, Line 25(II)  The state board of nursing created in section

• Page 8, Line 2612-255-105; or

• Page 8, Line 27(III)  Another applicable regulator.

• Page 9, Line 1(d) (I)  If the department refers an incident investigated

• Page 9, Line 2pursuant to subsection (2.5)(b) of this section to a regulator,

• Page 9, Line 3the regulator shall comply with the provisions of title 12

• Page 9, Line 4concerning the initiation and review of disciplinary actions and

• Page 9, Line 5the imposition of sanctions.

• Page 9, Line 6(II)  In addition to other sanctions that may be imposed by

• Page 9, Line 7a regulator upon a health-care practitioner who is found to

• Page 9, Line 8have contributed to a birthing parent's severe maternal

• Page 9, Line 9morbidity or death through racially discriminatory treatment

• Page 9, Line 10or explicit or implicit bias, the regulator may require the

• Page 9, Line 11health-care practitioner to participate in training relating to

• Page 9, Line 12anti-racism and bias-free clinical decision-making.

• Page 9, Line 13(III)  Notwithstanding any provision of title 12 to the

• Page 9, Line 14contrary, a regulator may impose a fine on a health-care

• Page 9, Line 15practitioner for a violation of this subsection (2.5).

• Page 9, Line 16Notwithstanding section 12-20-404 (6), the state treasurer shall

• Page 9, Line 17credit a fine collected pursuant to this subsection (2.5)(d) to the

• Page 9, Line 18fund.

• Page 9, Line 19(e) (I)  Notwithstanding any provision of this title 25 to

• Page 9, Line 20the contrary, if the department determines that a health

• Page 9, Line 21facility has engaged in discriminatory practices, failed to

• Page 9, Line 22follow evidence-based standards of obstetric care, or refused

• Page 9, Line 23to act on known symptoms that resulted in a birthing parent's

• Page 9, Line 24preventable severe maternal morbidity or death, in addition to

• Page 9, Line 25any other penalties, the department may:

• Page 9, Line 26(A)  Suspend or revoke the health facility's license; and

• Page 9, Line 27(B)  Impose an administrative penalty of up to two hundred

• Page 10, Line 1fifty thousand dollars per violation.

• Page 10, Line 2(II)  The state treasurer shall credit a penalty collected

• Page 10, Line 3to the fund.

• Page 10, Line 4(f)  A health facility and health-care practitioner shall

• Page 10, Line 5not retaliate against a birthing parent, a birthing companion, a

• Page 10, Line 6family member, an employee, a maternal health advocate, or

• Page 10, Line 7other individual who reports concerns regarding discrimination

• Page 10, Line 8or inequitable or unsafe maternal care.

• Page 10, Line 9(g)  The department may seek, accept, and expend gifts,

• Page 10, Line 10grants, or donations from private or public sources for the

• Page 10, Line 11purposes of this subsection (2.5) and subsection (1.5) of this

• Page 10, Line 12section and for the implementation of measures that improve

• Page 10, Line 13maternal heath equity, especially with respect to Black

• Page 10, Line 14birthing parents, given the documented disparity in maternal

• Page 10, Line 15health outcomes for this population both within the state and

• Page 10, Line 16the nation. The state treasurer shall credit gifts, grants, or

• Page 10, Line 17donations received to the fund.

• Page 10, Line 18(h) (I)  The maternal health equity improvement fund is

• Page 10, Line 19created in the state treasury. The fund consists of:

• Page 10, Line 20(A)  Money credited to the fund pursuant to this

• Page 10, Line 21subsection (2.5);

• Page 10, Line 22(B)  Gifts, grants, and donations credited to the fund; and

• Page 10, Line 23(C)  Any other money that the general assembly may

• Page 10, Line 24appropriate or transfer to the fund.

• Page 10, Line 25(II)  The state treasurer shall credit all interest and

• Page 10, Line 26income derived from the deposit and investment of money in the

• Page 10, Line 27fund to the fund.

• Page 11, Line 1(III)  Subject to annual appropriation by the general

• Page 11, Line 2assembly, the department may expend money from the fund to:

• Page 11, Line 3(A)  Support Black maternal health advocates and other

• Page 11, Line 4maternal health advocates that work with populations

• Page 11, Line 5identified as disproportionately at risk for adverse maternal

• Page 11, Line 6health outcomes;

• Page 11, Line 7(B)  Address preventable maternal morbidity or death

• Page 11, Line 8among Black birthing parents;

• Page 11, Line 9(C)  Support culturally responsive doulas and midwives;

• Page 11, Line 10(D)  Provide training for health-care practitioners on

• Page 11, Line 11racial bias;

• Page 11, Line 12(E)  Provide support for families after preventable severe

• Page 11, Line 13maternal morbidity or death; and

• Page 11, Line 14(F)  Support other initiatives to prevent adverse maternal

• Page 11, Line 15health outcomes.

• Page 11, Line 16(i)  Commencing with the department's office of health

• Page 11, Line 17equity reporting required in 2026 pursuant to section 25-4-2205

• Page 11, Line 18(2.5)(a)(I), the office of health equity shall publish aggregate,

• Page 11, Line 19de-identified data and information concerning:

• Page 11, Line 20(I)  Reports made pursuant to this subsection (2.5) of

• Page 11, Line 21severe maternal morbidity or death in which the report alleged

• Page 11, Line 22that racial discrimination, implicit or explicit bias, negligent

• Page 11, Line 23clinical decision-making, denial of care, or other inequitable

• Page 11, Line 24treatment contributed to the severe maternal morbidity or

• Page 11, Line 25death;

• Page 11, Line 26(II)  The outcome of department investigations made

• Page 11, Line 27pursuant to subsection (2.5)(b) of this section;

• Page 12, Line 1(III)  Related disciplinary actions taken by regulators

• Page 12, Line 2against health-care practitioners pursuant to subsection

• Page 12, Line 3(2.5)(d) of this section; and

• Page 12, Line 4(IV)  Related actions taken by the department or the

• Page 12, Line 5Colorado civil rights division in the department of regulatory

• Page 12, Line 6agencies against health facilities pursuant to subsection (2.5)(e)

• Page 12, Line 7of this section.

• Page 12, Line 8(j)  Definitions.As used in this subsection (2.5), unless the

• Page 12, Line 9context otherwise requires:

• Page 12, Line 10(I)  "Fund" means the maternal health equity improvement

• Page 12, Line 11fund created in subsection (2.5)(h) of this section.

• Page 12, Line 12(II)  "Health-care practitioner" means an individual

• Page 12, Line 13regulated pursuant to title 12 who is authorized to provide

• Page 12, Line 14health-care services during labor and childbirth.

• Page 12, Line 15(III)  "Health facility" means a facility licensed pursuant

• Page 12, Line 16to section 25-1.5-103 (1) or article 3 of this title 25 at which

• Page 12, Line 17labor and childbirth services are regularly provided.

• Page 12, Line 18(IV)  "Regulator" has the meaning set forth in section

• Page 12, Line 1912-20-102 (14).

• Page 12, Line 20SECTION 5.  In Colorado Revised Statutes, 25-4-2205, add

• Page 12, Line 21(2.5)(a)(III) and (4) as follows:

• Page 12, Line 2225-4-2205.  Powers and duties of the office of health equity -

• Page 12, Line 23rules - report - working group.

• Page 12, Line 24(2.5) (a) (III)  Commencing with the report published in 2026

• Page 12, Line 25pursuant to subsection (2.5)(a)(I) of this section, the department

• Page 12, Line 26shall include in the report aggregate, de-identified data and

• Page 12, Line 27information required pursuant to section 25-3-126 (2.5).

• Page 13, Line 1(4)  Notwithstanding the requirement in section 24-1-136

• Page 13, Line 2(11)(a)(I), the requirement to publish the report required in this

• Page 13, Line 3section continues indefinitely.

• Page 13, Line 4SECTION 6.  In Colorado Revised Statutes, 25-52-104, amend

• Page 13, Line 5(5)(c)(II), (5)(c)(III), and (6)(a) introductory portion; and add (5)(c)(IV),

• Page 13, Line 6(5.3), and (6)(a)(VI) as follows:

• Page 13, Line 725-52-104.  Colorado maternal mortality review committee -

• Page 13, Line 8creation - members - duties - report to the general assembly -

• Page 13, Line 9maternal health task force.

• Page 13, Line 10(5)  The department shall:

• Page 13, Line 11(c)  Incorporate input and feedback from:

• Page 13, Line 12(II)  Multidisciplinary, nonprofit organizations representing

• Page 13, Line 13persons individuals who are pregnant or in the postpartum period, with

• Page 13, Line 14a focus on persons individuals from racial and ethnic minority groups;

• Page 13, Line 15and

• Page 13, Line 16(III)  Multidisciplinary, community-based organizations that

• Page 13, Line 17provide support or advocacy for persons individuals who are pregnant

• Page 13, Line 18or in the postpartum period, with a focus on persons individuals from

• Page 13, Line 19racial and ethnic minority groups; and

• Page 13, Line 20(IV)  The maternal health task force described in

• Page 13, Line 21subsection (5.3) of this section;

• Page 13, Line 22(5.3)  As part of the federal grant that the department

• Page 13, Line 23administers through the state maternal health innovation and

• Page 13, Line 24data capacity program of the health resources and services

• Page 13, Line 25administration in the federal department of human services, the

• Page 13, Line 26department has established the maternal health task force,

• Page 13, Line 27referred to in this subsection (5.3) as the "task force", which is

• Page 14, Line 1convened by the department and the perinatal quality

• Page 14, Line 2collaborative. The department shall ensure that at least one

• Page 14, Line 3Black maternal health advocate serves on the task force. In

• Page 14, Line 4addition to other duties, the task force provides input and

• Page 14, Line 5feedback to the department and to the committee concerning

• Page 14, Line 6maternal health outcomes for Black birthing parents and

• Page 14, Line 7suspected and known causes of disparate outcomes for Black

• Page 14, Line 8birthing parents.

• Page 14, Line 9(6) (a)  No later than July 1, 2020, and July 1 every three years

• Page 14, Line 10thereafter through July 1, 2026, and, commencing July 1, 2027, each

• Page 14, Line 11July 1 thereafter, the department shall submit a report to the house of

• Page 14, Line 12representatives committees on public and behavioral health and human

• Page 14, Line 13services and health and insurance health and human services

• Page 14, Line 14committee and the senate committee on health and human services

• Page 14, Line 15committee, or their successor committees. The report must include:

• Page 14, Line 16(VI)  Maternal health outcomes for Black birthing

• Page 14, Line 17parents and suspected or known causes of any disparate

• Page 14, Line 18outcomes for Black birthing parents.

• Page 14, Line 19SECTION 7.  Applicability. This act applies to conduct occurring

• Page 14, Line 20on or after the effective date of this act.

• Page 14, Line 21SECTION 8.  Safety clause. The general assembly finds,

• Page 14, Line 22determines, and declares that this act is necessary for the immediate

• Page 14, Line 23preservation of the public peace, health, or safety or for appropriations for

• Page 14, Line 24the support and maintenance of the departments of the state and state

• Page 14, Line 25institutions.