C.R.S. § 25-52-101 Short title
25-52-101. Short title. The short title of this article 52 is the "Maternal Mortality Prevention Act".
Maternal Mortality Prevention Act
C.R.S. tit. 25, art. 52
in effectC.R.S. § 25-52-102 Legislative declaration
25-52-102. Legislative declaration. (1) The general assembly hereby finds and declares that:
(a) Colorado's maternal mortality rate nearly doubled between 2008 and 2013;
(b) Maternal deaths affect women statewide and are more common among families living in rural areas than in urban centers and disproportionately high among black and African-American women compared to white women;
(c) Eighty percent of maternal deaths in Colorado are considered preventable;
(d) To review deaths in the pregnant and postpartum population requires a holistic view of the circumstances surrounding a death. National research indicates that high blood pressure and cardiovascular disease remain two leading causes of maternal deaths nationwide, while in Colorado behavioral health conditions and self-harm now account for the largest share of maternal deaths.
(e) Evidence-based prevention strategies support the review of maternal deaths through state-based maternal mortality reviews in order to identify the systematic changes needed to decrease mortality among the pregnant and postpartum population;
(f) The department has had an active and dedicated committee of volunteer professionals reviewing maternal deaths since 1993; however, the capacity of the committee is limited by a lack of protection, funding, and authority;
(g) There is a need to establish a committee to review deaths among the pregnant and postpartum population and to recommend strategies to prevent these deaths and improve maternal health outcomes in Colorado;
(h) The prevention of deaths among the pregnant and postpartum population is a community responsibility, and professionals from a variety of disciplines have expertise that can promote the safety and well-being of the pregnant and postpartum population;
(i) Comprehensive and multidisciplinary reviews of maternal deaths can lead to a greater understanding of the causes of and methods for preventing these deaths and improve other maternal health outcomes including morbidity;
(j) The protection of the health and welfare of the pregnant and postpartum population in this state is an important goal of the citizens of this state, and the rate of death among the pregnant and postpartum population is a serious public health concern that requires legislative action;
(k) Forty-one states and the District of Columbia currently have statutorily created maternal mortality review committees; and
(l) Therefore, it is the intent of the general assembly to establish a maternal mortality review committee within the department to review maternal deaths and to recommend strategies for the prevention of maternal mortality.
C.R.S. § 25-52-103 Definitions
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.
C.R.S. § 25-52-104 Colorado maternal mortality review committee - creation - members - duties - report to the general assembly
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;
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;
ily, 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.
n 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.
C.R.S. § 25-52-105 Access to health records related to maternal mortalities
25-52-105. Access to health records related to maternal mortalities. (1) (a) Except as otherwise provided by law, the committee may access medical records related to maternal deaths upon request at any time up to seven years after the last treatment of a patient.
(b) A health-care provider or a health-care facility licensed or certified pursuant to article 3 of this title 25 shall provide medical records to the department concerning each maternal mortality for access by the members of the committee.
(c) Upon request of the department, a law enforcement officer shall provide a police report, and a coroner shall provide records of the coroner and medical examiner investigations, that involve a maternal death to the committee.
(d) A health-care provider, pharmacist, health-care facility, law enforcement officer, or coroner is not civilly or criminally liable for the release of medical records when making a good-faith effort to comply with this subsection (1).
(2) (a) The discussions in committee meetings or meetings of an ad hoc panel formed pursuant to section 25-52-104 (3) concerning details of a maternal death that could identify an individual involved are confidential and are not subject to section 24-6-402.
(b) The committee meeting notes, statements, medical records, reports, communications, and memoranda obtained by the committee that contain information that could identify an individual involved in a maternal death are confidential and are not subject to the "Colorado Open Records Act", part 2 of article 72 of title 24.
(c) Members of the committee are not subject to subpoena in any civil, criminal, or administrative proceeding regarding the information presented in or opinions formed as a result of a meeting or communication of the committee; except that this subsection (2)(c) does not prevent a member of the committee from testifying regarding information or opinions obtained independently of the committee or that are public information.
(d) Notes, statements, medical records, reports, communications, and memoranda that are confidential pursuant to subsections (2)(a) and (2)(b) of this section are not:
(I) Subject to subpoena, discovery, or introduction into evidence in any civil, criminal, or administrative proceeding, unless the subpoena is directed to a source that is separate and apart from the committee. Nothing in this section limits or restricts the right to discover or use in a civil, criminal, or administrative proceeding notes, statements, medical records, reports, communications, or memoranda that are available from another source separate and apart from the committee and that arise entirely independent of the committee's activities.
(II) Admissible as evidence in any action in any court or before any tribunal, board, agency, or person and shall not be exhibited or disclosed in any way by any person unless the information was obtained from another source that is separate and apart from the committee, except as may be necessary to further the duties of the committee or in response to an alleged violation of a confidentiality agreement pursuant to subsection (2)(e) of this section.
(e) Each committee member shall sign a confidentiality agreement that requires the member's adherence to subsections (2)(a) and (2)(b) of this section. A member who knowingly violates the confidentiality agreement commits a petty offense.
C.R.S. § 25-52-106 Duty to comply with state and federal laws relating to health information
25-52-106. Duty to comply with state and federal laws relating to health information. The committee and the department shall comply with all applicable state and federal laws and rules relating to the transmission of health information.
C.R.S. § 25-52-106.5 Perinatal health quality improvement program - perinatal health quality improvement engagement program - perinatal quality collaborative duties - data collection - reporting - legislative declaration - definitions
25-52-106.5. Perinatal health quality improvement program - perinatal health quality improvement engagement program - perinatal quality collaborative duties - data collection - reporting - legislative declaration - definitions. (1) The general assembly finds and declares that:
(a) Disparities in maternal and infant health-care access, delivery, and outcomes in Colorado persist, such that birthing people who are American Indian/Alaska Native are nearly three times more likely to die during pregnancy or within one year postpartum than the overall population of those giving birth in Colorado;
(b) Birthing people who are Black are nearly two times more likely to die during pregnancy or within one year postpartum than the overall population of those giving birth in Colorado;
(c) Birthing people living in frontier counties are more likely to die from pregnancy-related causes than those living in urban counties, and people insured through the medical assistance program are more likely to die during pregnancy or within one year postpartum than those with private insurance;
(d) Discrimination contributed to half of all pregnancy-associated deaths in Colorado, and ninety percent of all deaths were deemed preventable by the Colorado maternal mortality review committee;
(e) In 2022, the United States' infant mortality rate increased for the first time in two decades. Infants born to Black and Native American birthing people are two times more likely to die compared with their white and Hispanic counterparts.
(f) The committee and the maternal health task force established by the department recommend statewide, universal participation in quality improvement initiatives led by the perinatal quality collaborative and the adoption of Alliance for Innovation on Maternal Health patient safety bundles;
(g) The National Governors Association, through its maternal and infant health initiative, similarly recommends the adoption of patient safety bundles and increased funding for state maternal mortality review committees and perinatal quality collaboratives;
(h) Ninety-six percent of births in Colorado occur in hospitals, and there is a need to provide practical support to hospitals, especially frontier and rural hospitals, for the implementation of clinical quality improvement initiatives; and
(i) Participation in state perinatal quality collaboratives has been shown to improve maternal and infant health outcomes through improved access to, and the timeliness of, treatment and through reduced serious pregnancy complications.
(2) As used in this section, unless the context otherwise requires:
(a) "Engagement program" means the perinatal health quality improvement engagement program created in subsection (5) of this section.
(b) "Hospital" means a hospital licensed or certified pursuant to section 25-1.5-103 that provides nonemergent perinatal care services.
(c) "Quality improvement program" means the hospital perinatal health quality improvement program created in subsection (4) of this section.
(3) (a) The department shall contract with the perinatal quality collaborative to:
(I) Track statewide implementation of the committee's recommendations to prevent maternal mortality;
(II) Implement hospital quality improvement programs through perinatal care settings to reduce preventable causes of maternal mortality and morbidity; and
(III) Address disparate care of and outcomes among American Indian/Alaska Native and Black birthing populations, birthing people insured through the medical assistance program, and birthing people living in rural and frontier counties.
tality;
(II) Implement hospital quality improvement programs through perinatal care settings to reduce preventable causes of maternal mortality and morbidity; and
(III) Address disparate care of and outcomes among American Indian/Alaska Native and Black birthing populations, birthing people insured through the medical assistance program, and birthing people living in rural and frontier counties.
(b) In implementing hospital quality improvement programs, the perinatal quality collaborative shall provide quality improvement program support that may include:
(I) Clinical quality improvement science education concerning best practices and innovations to support optimal outcomes;
(II) Tailored interventions designed to address the needs of priority populations;
(III) Individualized program implementation guidance and support;
(IV) Data reporting, analysis, and rapid response feedback for assistance in monitoring the sustainability of implemented changes;
(V) Provider training in stigma, bias, and trauma-informed and respectful care; and
(VI) Public recognition as a maternal and infant care quality champion.
(c) The department shall provide vital statistics data to the perinatal quality collaborative for purposes of data analysis and reporting. The perinatal quality collaborative shall develop a data-sharing agreement with the department to identify specific vital statistics data that must be shared. The data-sharing agreement must address the confidentiality of data to ensure that data sharing is protected.
(4) Hospital perinatal health quality improvement program. A hospital shall:
(a) No later than July 1, 2025, and no later than July 1 each year thereafter, submit to the perinatal quality collaborative, either directly or through a statewide association of hospitals, a minimum data set of key drivers of disparities in perinatal health care and health-care outcomes, maternal mortality and severe maternal morbidity, and infant health care and health-care outcomes, including:
(I) Cesarean deliveries;
(II) Perinatal hypertension, sepsis, and cardiac conditions;
(III) Maternal and neonatal readmissions and length of stay;
(IV) Unexpected newborn complications;
(V) Perinatal mental health and substance use conditions;
(VI) Obstetric hemorrhage; and
(VII) Preterm birth; and
(b) Beginning December 15, 2025, participate annually in at least one maternal or infant health quality improvement initiative, as determined by the hospital, in collaboration with the perinatal quality collaborative pursuant to subsection (3) of this section, with the goal of:
(I) Promoting evidence-based, culturally relevant, safe, equitable, high-quality care; and
(II) Preventing maternal and infant mortality and severe morbidity.
(5) Perinatal health quality improvement engagement program. (a) No later than July 1, 2025, the department shall create a perinatal health quality improvement engagement program that provides financial support to hospitals and facilities that provide emergent labor and delivery or perinatal care services that do not have sufficient resources to participate in one or more maternal or infant health quality improvement initiatives pursuant to subsection (4) of this section.
(b) The department shall select hospitals and facilities that provide emergent labor and delivery or perinatal care services to participate in the engagement program and may contract with the perinatal quality collaborative to administer the engagement program. In order to participate in the engagement program, a hospital or facility must commit to work with the perinatal quality collaborative on the maternal or infant health quality improvement initiatives selected by the hospital or facility.
r perinatal care services to participate in the engagement program and may contract with the perinatal quality collaborative to administer the engagement program. In order to participate in the engagement program, a hospital or facility must commit to work with the perinatal quality collaborative on the maternal or infant health quality improvement initiatives selected by the hospital or facility.
(c) The department shall prioritize financial support for hospitals and facilities that:
(I) Are in rural and frontier areas of the state;
(II) Qualify for disproportionate share payments under the medical assistance program; or
(III) Have lower-acuity maternal or neonatal levels of care designations.
(d) Hospitals and facilities receiving financial support pursuant to the engagement program may use the financial support for quality improvement, including dedicated staff time, training costs, travel, continuing education, and data entry and technical assistance.
(6) Collaboration with the perinatal quality collaborative. (a) The department shall contract with the perinatal quality collaborative to:
(I) Track statewide implementation of the committee's recommendations, developed pursuant to section 25-52-104, to prevent maternal mortality; and
(II) No later than July 1, 2026, and no later than July 1 each year thereafter, issue a report to the department concerning:
(A) Clinical quality improvement efforts to reduce disparities in perinatal health outcomes and to prevent maternal and infant mortality and morbidity that includes relevant, aggregate hospital maternal and infant health quality metrics and that may be distributed to policymakers, health-care providers, hospitals and other health facilities, public health professionals, and other interested persons to assist the department in promoting data access and facilitating additional efforts to reduce maternal and infant mortality and morbidity;
(B) Hospital participation in maternal and infant perinatal quality improvement initiatives pursuant to subsection (4)(b) of this section;
(C) Implementation of the federal health resources and services administration maternal and child health bureau's and American College of Obstetricians and Gynecologists' alliance for innovation on maternal health patient safety bundles and related performance metrics, including the status of addressing drivers of perinatal health disparities and maternal and infant mortality and morbidity as described in subsection (4)(a) of this section; and
(D) Areas of opportunity for ongoing improvement.
(b) In compliance with all applicable state and federal laws relating to the publication of health information and legally binding data use agreements, the perinatal quality collaborative and the department shall make an aggregated and de-identified report prepared pursuant to subsection (6)(a)(II) of this section publicly available on the department's website and on the website of the perinatal quality collaborative.
(c) The perinatal quality collaborative shall consult with a statewide association of hospitals and with diverse hospital leadership to support ongoing hospital engagement in quality improvement and to advise practitioners in clinical settings across the state on the advancement of best practices to reduce maternal and infant mortality and morbidity.
(d) Data submitted pursuant to subsection (4)(a) of this section is considered confidential and proprietary, contains trade secrets, or is not a public record pursuant to part 2 of article 72 of title 24 and is only reportable in an aggregated and de-identified manner.
C.R.S. § 25-52-107 Repeal of article - review of functions
25-52-107. Repeal of article - review of functions. This article 52 is repealed, effective September 1, 2029. Before the repeal, the functions of the committee are scheduled for review in accordance with section 2-3-1203.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://leg.colorado.gov/sites/default/files/images/olls/crs2024-title-25.docxFetched: 10/6/2026