§ 25-52-103 — Definitions

As used in this article 52, unless the context
otherwise requires:

(1) Committee means the Colorado maternal mortality review committee
created in section 25-52-104.

(2) Department means the department of public health and environment.

(3) Designated state perinatal care quality collaborative or perinatal
quality collaborative means a statewide nonprofit network of health facilities,
clinicians, and public health professionals working to improve the quality of care for
mothers and babies through continuous quality improvement.

(4) Health-care provider means any person licensed, registered, or
certified by the state of Colorado to deliver health-care services, including mental
and behavioral health-care services and medical marijuana services.

(4.5) Health facility means a health facility licensed or certified pursuant
to section 25-1.5-103 (1).

(5) Maternal death means a death that occurs during pregnancy or up to
one year after the end of a pregnancy.

(6) Maternal mortality means the incidence of maternal deaths.

(6.5) Medical assistance program means the medical assistance program
established pursuant to articles 4 to 6 of title 25.5.

(7) (a) Medical record means the written or graphic documentation, sound
recording, or computer record pertaining to health-care services performed at the
direction of a health-care provider on behalf of a patient.

(b) Medical record includes:

(I) Diagnostic documentation such as X rays, electrocardiograms,
electroencephalograms, and other test results;

(II) Data entered into the electronic prescription drug monitoring program
under section 12-280-403;

(III) Data entered into the national violent death reporting system or a
successor system; and

(IV) Autopsy reports.

(8) Pregnancy-related death means a death caused by issues related to, or
aggravated by, a pregnancy or treatment of that pregnancy.

Source: L. 2019: Entire article added, (HB 19-1122), ch. 196, p. 2139, � 1,
effective May 16. L. 2021: (3) amended and (4.5) added, (SB 21-194), ch. 434, p.
2869, � 4, effective September 7. L. 2024: (3) amended and (6.5) added, (SB 24-175), ch. 433, p. 3035, � 3, effective June 5.

25-52-104. Colorado maternal mortality review committee - creation -
members - duties - report to the general assembly. (1) The Colorado maternal
mortality review committee is hereby created in the department for the purposes
of:

(a) Reviewing specific cases of maternal death that occur in Colorado;

(b) Identifying the causes of maternal mortality; and

(c) Developing recommendations to address preventable maternal deaths,
including legislation, policies, rules, training, and best practices that will support
the health and safety of the pregnant and postpartum population in Colorado and
prevent maternal deaths.

(2) (a) By October 1, 2019, the executive director of the department shall
appoint at least eleven members to serve on the committee. The term of
appointment is three years; except that the term of the first six members appointed
is two years. Members may serve up to three terms. The executive director may fill
any vacancies on the committee.

(b) In appointing members to the committee, the executive director shall:

(I) Follow best practices as outlined by the centers for disease control and
prevention in the federal department of health and human services;

(II) Ensure that committee members represent diverse communities and a
variety of clinical, forensic, and psychosocial specializations and community
perspectives, including community-based midwifery; and

(III) Make an effort to include committee members working in and
representing communities that are:

(A) Diverse with regard to race, ethnicity, immigration status, English
proficiency, income, wealth, and geographic region of the state, including both
urban and rural areas; and

(B) Affected by higher rates of maternal mortality and by a lack of access to
the full scope of maternity care health services.

(c) The members of the committee who reside more than fifty miles from the
location of a committee hearing are entitled to receive the same per diem
compensation and reimbursement of expenses as those provided for members of
boards and commissions pursuant to section 12-20-103 (6), and for expenses
incurred in traveling to and from the meetings of the committee, including any
required dependent or attendant travel, food, and lodging. Members of the
committee are also entitled to reimbursement for any expenses necessary to
support the members' participation at a committee hearing, including any
dependent or attendant care.

(3) The committee may form special ad hoc panels to further investigate
cases of maternal death resulting from specific causes when the need arises.

(4) The committee shall:

(a) Review each death in Colorado that is a maternal death;

(b) Review medical records and other relevant data related to each maternal
death;

(c) Take steps to improve the quality and scope of data obtained through
investigations and review of maternal deaths;

(d) Identify the causes of maternal mortality, including any trends and
patterns across racial, geographic, and other groups;

(e) Develop recommendations for the prevention of maternal mortality and
deliver the recommendations to the department;

(f) Perform any other functions as resources allow to enhance the capability
of the state to reduce and prevent maternal mortality; and

(g) Advise the department in the department's work on decreasing maternal
mortality.

(5) The department shall:

(a) Compile reports of aggregated, nonindividually identifiable data on a
routine basis for distribution in an effort to further study the causes and problems
associated with maternal mortality that may be distributed to policymakers, health-care providers, health facilities, behavioral health providers, public health
professionals, the health equity commission created in section 25-4-2206, and
others necessary to reduce the maternal mortality rate;

(b) Serve as a link with maternal mortality review teams throughout the
country and participate in regional or national maternal mortality review team
activities;

(c) Incorporate input and feedback from:

(I) Interested and affected stakeholders, with a focus on persons who are
pregnant or in the postpartum period and their family members;

(II) Multidisciplinary, nonprofit organizations representing persons who are
pregnant or in the postpartum period, with a focus on persons from racial and
ethnic minority groups; and

(III) Multidisciplinary, community-based organizations that provide support
or advocacy for persons who are pregnant or in the postpartum period, with a focus
on persons from racial and ethnic minority groups;

(d) Make recommendations to improve the collection and public reporting of
maternal health data from hospitals, health systems, insurers, maternal care
providers, pharmacies, local and state law enforcement offices, behavioral health
treatment facilities, and substance use disorder treatment facilities, including:

(I) Data on race and ethnicity correlated with conditions and outcomes;
disability correlated with conditions and outcomes; uptake of trainings on bias,
racism, or discrimination; and incidents of disrespect or mistreatment of a pregnant
person; and

(II) Data collected through stories from pregnant and postpartum persons
and their family members, with a focus on the experiences of marginalized groups
including persons of racial and ethnic minority groups; and

(e) Study the use of research evidence in policies related to the perinatal
period in Colorado and, no later than September 1, 2023, report to the senate
committee on health and human services and the house of representatives
committee on health and insurance, or their successor committees, on the use of
research evidence in policies related to the perinatal period in the state, including
public and private payment systems and malpractice insurance policies, using the
implementation science framework. To fulfill the requirements of this subsection
(5)(e), the department may contract with a third party and request information from
insurers offering medical malpractice policies in the state regarding the insurer's
policies related to labor and delivery services.

(5.5) The department may contract with an independent third-party
evaluator to:

(a) Study closures, consolidations, and acquisitions related to perinatal
health-care practices and facilities and perinatal state-designated health
professional shortage areas, as defined in section 25-1.5-402 (11), and assets and
deficits related to perinatal health and health-care services across the state, not
limited to obstetric providers;

(b) Identify major outcome categories at the clinical, family, community, and
provider levels that the department should track over time and identify risks and
opportunities related to closures, consolidations, and acquisitions of perinatal
health-care practices and facilities;

(c) Explore the effects of practice and facility closures on maternal and
infant health outcomes and experiences, to illustrate structural needs around
closures, when applicable;

(d) Identify recommendations during practice and facility closures and
resultant transfers of care. The department or third-party evaluator may use both
primary and secondary data in making the recommendations. The department or
third-party evaluator shall use the map created pursuant to subsection (5.5)(f) of
this section in developing the recommendations. The recommendations must:

(I) Include solutions at the facility level, the practice level, the workforce
level, the community level, and the patient level;

(II) Include minimum requirements for reporting on closures, including
metrics on timelines and geographic area, including whether the timeline created in
section 25-3-131 is appropriate;

(III) Develop recommendations on primary and secondary data collection
related to closures and resultant transfers of care.

(e) Identify best practice guidelines during practice and facility closures and
resultant transfers of care. The third-party evaluator may use both primary and
secondary data in identifying the best practice guidelines. The third-party evaluator
shall use the map created pursuant to subsection (5.5)(f) of this section in
developing the guidelines. The guidelines must consider the following areas: Risks
and opportunities; transfers of care; community notice needs and opportunities;
notification to the department; closure timeline; and resources needed by facilities,
providers, and families.

(f) Create a health professional shortage area and perinatal health services
assets and deficits asset map that identifies by perinatal service area:

(I) Primary health-care providers, including physicians and midwives of all
credential types who provide or could be providing perinatal health care;

(II) The type and location of perinatal health care offered by the providers
listed pursuant to subsection (5.5)(f)(I) of this section;

(III) Community-based perinatal health-care workers, such as doulas,
childbirth educators, and lactation support consultants; and

(IV) Resources such as community advocates, gathering places, and
educational hubs;

(g) By July 1, 2026, deliver the best practices and recommendations created
pursuant to this subsection (5.5) to the house of representatives health and human
services committee and the senate health and human services committee, or their
successor committees.

(6) (a) No later than July 1, 2020, and July 1 every three years thereafter, the
department shall submit a report to the house of representatives committees on
public and behavioral health and human services and health and insurance and the
senate committee on health and human services, or their successor committees.
The report must include:

(I) In consultation with health equity experts, recommendations to achieve
equity in maternal health outcomes in Colorado;

(II) Recommendations to reduce the incidence of preventable maternal
mortality and related morbidity;

(III) A prioritization of a limited number of causes of maternal mortality that
are identified as having the greatest impact on the pregnant and postpartum
population in Colorado and as most preventable;

(IV) In consultation with the designated state perinatal care quality
collaborative, recommendations for clinical quality improvement approaches that
could reduce the incidence of pregnancy-related deaths or maternal mortality or
morbidity in prenatal, perinatal, and postnatal clinical settings and
recommendations for how to spread best practices to clinical settings across the
state; and

(V) Repealed.

(b) The department shall post the report prepared in accordance with this
subsection (6) on its website.

(c) Notwithstanding section 24-1-136 (11)(a)(I), the reporting required by this
subsection (6) continues indefinitely.

Source: L. 2019: Entire article added, (HB 19-1122), ch. 196, p. 2140, � 1,
effective May 16. L. 2021: (5), IP(6)(a), (6)(a)(III), and (6)(a)(IV) amended and (6)(a)(V)
added, (SB 21-194), ch. 434, p. 2869, � 5, effective September 7. L. 2024: (2)(b)(II)
amended and (5.5) added, (HB 24-1262), ch. 393, p. 2712, � 7, effective June 4.

Editor's note: Subsection (6)(a)(V)(B) provided for the repeal of subsection
(6)(a)(V), effective September 1, 2024. (See L. 2021, p. 2869.)

Cross references: For the legislative declaration in HB 24-1262, see section 1
of chapter 393, Session Laws of Colorado 2024.