Colorado § 25.5-4-506 - Coverage for doula services - stakeholder process - federal authorization - scholarship program - training - report - definitions.

§ 25.5-4-506. Coverage for doula services - stakeholder process - federal authorization - scholarship program - training - report - definitions.

(1) As used in this section, unless the context otherwise requires:

(a) "Doula" means a trained birth companion who provides personal, nonmedical support to pregnant and postpartum people and their families prior to childbirth, during labor and delivery, and during the postpartum period.

(b) "Maternity advisory committee" means the committee facilitated by the state department composed predominantly of Black, Indigenous, and other people of color with maternity care experience as members.

(2) No later than September 1, 2023, the state department shall initiate a stakeholder process to promote the expansion and utilization of doula services for pregnant and postpartum members in the state. In conducting the stakeholder process, the state department shall:

(a) Design an outreach strategy that includes best practices in community engagement, including, but not limited to:

(I) Engaging trusted community partners to support the work;

(II) Reimbursement of participation costs for individuals who are not otherwise paid to participate;

(III) Reimbursement of child care costs for individuals who participate; and

(IV) Translation services and meeting times that allow diverse and inclusive participation;

(b) Solicit feedback related to:

(I) An approved doula certification process that incorporates national and local training programs;

(II) A billing process for doula services;

(III) Ways to recruit doulas and integrate them into hospital deliveries;

(IV) Support needed to build and retain a doula workforce;

(V) Community outreach to determine how to best promote doula services; and

(VI) The doula scholarship program created in subsection (7) of this section.

(3) Stakeholders must be diverse with regard to race, ethnicity, immigration status, sexual orientation, and gender, and must represent other populations that experience greater health disparities and inequities. The state department may include the following in the stakeholder process:

(a) Doulas and potential doulas who may serve members who include, but are not limited to, Black, Indigenous, and other people of color, refugees, non-English speakers, people living in rural areas, and people who were recently incarcerated;

(b) Individuals indirectly involved in the delivery of doula services, including, but not limited to, clinical providers, hospitals, managed care entities, and state partners, including, but not limited to, the department of public health and environment, department of human services, department of early childhood, and department of regulatory agencies;

(c) Representatives from the division of insurance with subject matter expertise;

(d) Representatives from the maternity advisory committee;

(e) Consumer advocates; and

(f) Experts on perinatal care and quality.

(4) For state fiscal year 2024-25, the state department shall submit a report to the general assembly as part of the state department's "SMART Act" presentation required by section 2-7-203. The report must include findings and recommendations from the stakeholder process as described in subsection (2) of this section. The state department shall work with the maternity advisory committee to create the report.

(5) In carrying out the stakeholder process described in subsection (2) of this section, the state department is exempt from the "Procurement Code", articles 101 to 112 of title 24.

(6) Not later than July 1, 2024, the state department shall seek federal authorization to provide doula services for pregnant and postpartum people to improve health outcomes of pregnant and postpartum people who face a disproportionately greater risk of poor birth outcomes.

(7) (a) Not later than July 1, 2024, the state department shall create a doula scholarship program that grants funds to individuals without sufficient financial resources to complete doula training and certification programs necessary to provide doula services.

(b) In designing the doula scholarship program, the state department shall solicit input from groups identified in subsection (3) of this section.

(c) The state department shall define eligibility criteria for the doula scholarship program that includes, but is not limited to, the following:

(I) Proof of financial hardship;

(II) Proof of state residency; and

(III) A statement of intent to serve as a doula provider in Colorado for pregnant and postpartum members.

(d) The state department shall define criteria for organizations to conduct training and certification programs for doulas that include, but are not limited to:

(I) An approved certification process for doulas;

(II) An equitable approach to doula recruitment and training; and

(III) An approved budget to provide free training to attendees.

(e) The state department may require individuals who receive scholarship money pursuant to the doula scholarship program described in this subsection (7) to submit to the state department, not later than six months after the individual's completion of doula training or certification, documentation that the individual is serving as a doula for members or is working toward enrollment as a doula for members. If an individual does not complete the documentation, the state department may seek repayment of the funds awarded to the individual through the doula scholarship program.

(f) Repealed.

(g) Notwithstanding section 24-1-136 (11)(a)(I), the state department shall report annually beginning in 2025 to the general assembly as part of the state department's "SMART Act" presentation, as required by section 2-7-203, on the utilization and outcomes of the doula scholarship program.

Source: L. 2023: Entire section added, (SB 23-288), ch. 279, p. 1652, § 2, effective May 30. L. 2024: (1)(b), IP(2), (3)(a), (7)(c)(III), and (7)(e) amended, (SB 24-176), ch. 152, p. 644, § 41, effective August 7.

Editor's note: Subsection (7)(f)(II) provided for the repeal of subsection (7)(f), effective July 1, 2026. (See L. 2023, p. 1652.)

Cross references: For the legislative declaration in SB 23-288, see section 1 of chapter 279, Session Laws of Colorado 2023.

ARTICLE 5

Colorado Medical Assistance Act - Services and Programs

PART 1

MANDATORY PROVISIONS

25.5-5-101. Mandatory provisions - eligible groups - rules.

25.5-5-102. Basic services for the categorically needy - mandated services - repeal.

25.5-5-103. Mandated programs with special state provisions - rules.

25.5-5-104. Qualified medicare beneficiaries.

25.5-5-105. Qualified disabled and working individuals.

PART 2

OPTIONAL PROVISIONS

25.5-5-201. Optional provisions - optional groups - rules.

25.5-5-202. Basic services for the categorically needy - optional services.

25.5-5-203. Optional programs with special state provisions.

25.5-5-204. Presumptive eligibility - pregnant person - children - long-term care - state plan.

25.5-5-204.5. Continuous eligibility - children.

25.5-5-205. Baby and kid care program - creation - eligibility. (Repealed)

25.5-5-206. Medicaid buy-in program - disabled children - disabled adults - federal authorization - rules.

25.5-5-207. Adult dental benefit - adult dental fund - creation - legislative declaration.

25.5-5-208. Additional services - training - grants - screening, brief intervention, and referral.

PART 3

SERVICES WITH SPECIAL STATE PROVISIONS

25.5-5-301. Clinic services.

25.5-5-302. Clinic services - children and pregnant women - utilization of certain providers.

25.5-5-303. Private-duty nursing.

25.5-5-304. Hospice care.

25.5-5-305. Pediatric hospice care - legislative declaration - federal authorization - rules - repeal. (Repealed)

25.5-5-306. Residential child health care - waiver - program - rules - notice to revisor - repeal. (Repealed)

25.5-5-307. Child mental health treatment and family support program.

25.5-5-308. Breast and cervical cancer prevention and treatment program - creation - legislative declaration - definitions - funds - repeal.

25.5-5-309. Pregnant women - needs assessment - referral to treatment program - definition.

25.5-5-310. Treatment program for high-risk pregnant and parenting women - cooperation with private entities - definition.

25.5-5-311. Treatment program for high-risk pregnant and parenting women - data collection.

25.5-5-312. Treatment program for high-risk pregnant and parenting women - extended coverage - federal approval.

25.5-5-313. Outpatient substance abuse treatment - report of state auditor - amendment to state plan - repeal. (Repealed)

25.5-5-314. Substance use disorder treatment for Native Americans - federal approval.

25.5-5-315. Acceptance of gifts, grants, and donations - Native American substance abuse treatment cash fund.

25.5-5-316. Legislative declaration - state department - disease management programs authorization - report.

25.5-5-317. Obesity treatment pilot program - development and implementation - report - repeal. (Repealed)

25.5-5-318. Health services - provision by school districts - repeal.

25.5-5-319. Family planning pilot program - rules - federal waiver - repeal.

25.5-5-320. Telemedicine - reimbursement - disclosure statement - rules - definition.

25.5-5-321. Telemedicine - home health care - home health telemedicine cash fund - rules.

25.5-5-321.5. Telehealth - interim therapeutic restorations - reimbursement - definitions.

25.5-5-322. Over-the-counter medications - rules.

25.5-5-323. Complex rehabilitation technology - no prior authorization - metrics - report - rules - legislative declaration - definitions.

25.5-5-324. Nonemergency medical transportation - urgent and secure transportation need - report - repeal. (Repealed)

25.5-5-325. Partial hospitalization and residential and inpatient substance use disorder treatment - medical detoxification services - federal approval - performance review report.

25.5-5-326. Access to clinical trials - definitions.

25.5-5-327. Eligible peer support services - reimbursement - definitions.

25.5-5-328. Secure transportation for behavioral health crises - benefit - funding.

25.5-5-329. Family planning services - federal authorization - rules - definitions.

25.5-5-330. Screening for perinatal mood and anxiety disorder.

25.5-5-331. Federally qualified health center - reimbursement - rules.

25.5-5-332. Therapy using equine movement - federal authorization - definition.

25.5-5-333. Primary care and behavioral health statewide integration grant program - creation - report - definition - repeal.

25.5-5-334. Community health worker services - federal authorization - reporting - rules - definition.

25.5-5-335. Continuous medical coverage for children and adults feasibility study - federal authorization - rules - report - definition.

25.5-5-336. Prohibition on using the body mass index or ideal body weight - medical necessity criteria.

25.5-5-337. Telehealth remote monitoring services for outpatient clinical services - grant program - federal authorization - rules - definitions.

25.5-5-338. Continuous glucose monitors - coverage - federal authorization - definition.

25.5-5-339. Coverage for services addressing health-related social needs feasibility study - federal authorization - rules.

25.5-5-340. Health-related social needs reinvestment cash fund - creation - definitions.

PART 4

STATEWIDE MANAGED CARE SYSTEM

25.5-5-401. Short title.

25.5-5-402. Statewide managed care system - rules - definitions - repeal.

25.5-5-403. Definitions.

25.5-5-404. Selection of managed care entities. (Repealed)

25.5-5-405. Quality measurements. (Repealed)

25.5-5-406. Required features of managed care system. (Repealed)

25.5-5-406.1. Required features of statewide managed care system.

25.5-5-407. State department recommendations - primary care physician program. (Repealed)

25.5-5-407.5. Prepaid inpatient health plan agreements - rules. (Repealed)

25.5-5-407.7. Disability care coordination organization - rules. (Repealed)

25.5-5-408. Capitation payments - availability of base data - adjustments - rate calculation - capitation payment proposal - preference - assignment of medicaid members - definition.

25.5-5-409. State department - privatization. (Repealed)

25.5-5-410. Data collection for managed care programs.

25.5-5-411. Medicaid community mental health services - legislative declaration - administration - rules. (Repealed)

25.5-5-412. Program of all-inclusive care for the elderly - services - eligibility - rules - legislative declaration - definitions.

25.5-5-413. Direct contracting with providers - legislative declaration. (Repealed)

25.5-5-414. Telemedicine - legislative intent.

25.5-5-415. Medicaid payment reform and innovation pilot program - creation - selection of payment projects - report - rules - legislative declaration.

25.5-5-416. Report concerning efficient contracting in managed care - legislative declaration - repeal. (Repealed)

25.5-5-417. Reducing unnecessary duplicative services in the accountable care collaborative program - repeal. (Repealed)

25.5-5-418. Primary care provider sustainability fund - creation - use of fund - repeal. (Repealed)

25.5-5-419. Accountable care collaborative - reporting - rules.

25.5-5-420. Advancing care for exceptional kids.

25.5-5-421. Parity reporting - state department - public input.

25.5-5-422. Medication-assisted treatment - limitations on MCEs - definition.

25.5-5-423. Independent review organization - review denial of residential and inpatient substance use disorder treatment claims - contract.

25.5-5-424. Residential and inpatient substance use disorder treatment - MCE standardized utilization management process - medical necessity - report.

25.5-5-425. Audit of MCE denials for residential and inpatient substance use disorder treatment authorization - report.

25.5-5-426. Managed care entities - behavioral health providers - disclosure of reimbursement rates.

25.5-5-427. Managed care entities - disclosure of payment and medical loss ratio - definition.

25.5-5-428. Secure transportation providers - accessible list.

PART 5

PRESCRIPTION DRUGS

25.5-5-500.3. Authorization to bill third party.

25.5-5-501. Providers - drug reimbursement.

25.5-5-502. Unused medications - reuse - rules - definition.

25.5-5-503. Prescription drug benefits - authorization - dual-eligible participation.

25.5-5-504. Providers of pharmaceutical services.

25.5-5-505. Prescribed drugs - mail order - rules.

25.5-5-506. Prescribed drugs - utilization review.

25.5-5-507. Prescription drug information and technical assistance program - rules.

25.5-5-508. Electronic prescriptions - study - report - repeal. (Repealed)

25.5-5-509. Substance use disorder - prescription drugs - opioid antagonist - definition.

25.5-5-510. Pharmacy reimbursement - substance use disorder - injections.

25.5-5-511. Reimbursement for pharmacists' services - legislative declaration.

25.5-5-512. Pharmacy benefit - mental health and substance use disorders - legislative declaration.

25.5-5-512.5. Medications for opioid use disorder - pharmacists - reimbursement - definition.

25.5-5-513. Pharmacy benefits - prescription drugs - rebates - analysis.

25.5-5-514. Prescription drugs used for treatment or prevention of HIV - prohibition on utilization management - definition.

25.5-5-515. Pharmacy reimbursement - vaccine administration to children - legislative declaration.

25.5-5-516. Serious mental illness - prescribed drugs.

25.5-5-517. Prescription drugs for treating mental health disorders or conditions - prior authorization - rules - definitions.

25.5-5-518. Coverage for choline dietary supplements - rules.

25.5-5-519. Pharmacy reimbursement - parenteral nutrition - report - definitions.

PART 6

PROGRAM FOR TEEN PREGNANCY AND DROPOUT PREVENTION

25.5-5-601 to

25.5-5-605. (Repealed)

PART 7

TELEMEDICINE PILOT PROGRAMS FOR CHRONIC MEDICAL CONDITIONS

25.5-5-701 to

25.5-5-703. (Repealed)

PART 8

CHILDREN AND YOUTH BEHAVIORAL HEALTH SYSTEM IMPROVEMENTS

25.5-5-801. Legislative declaration.

25.5-5-802. Definitions.

25.5-5-803. High-fidelity wraparound services for children and youth - federal approval - reporting.

25.5-5-804. Integrated funding pilot.

PART 1

MANDATORY PROVISIONS