SB 299
Department of Legislative Services
Maryland General Assembly
2021 Session
FISCAL AND POLICY NOTE
Third Reader - Revised
Senate Bill 299 (Senator Carter, et al.)
Finance Health and Government Operations
Human Services - Trauma-Informed Care - Commission and Training (Healing
Maryland's Trauma Act)
This bill establishes the Commission on Trauma-Informed Care as an independent
commission in the Department of Human Services (DHS) to coordinate a statewide
initiative to prioritize the trauma-responsive and trauma-informed delivery of State
services that affect children, youth, families, and older adults. The Governor’s Office of
Crime Prevention, Youth, and Victim Services (GOCPYVS) must provide staff to the
commission. The commission, in consultation with specified entities, must study and
implement an Adverse Childhood Experiences (ACEs) Aware program. The bill requires
each commission member to participate in specified training and each specified agency
head to designate two staff members to carry out specified responsibilities. Members of the
commission may not receive compensation but are eligible for reimbursement under
standard State travel regulations. The bill takes effect July 1, 2021.
Fiscal Summary
State Effect: General fund expenditures increase by $61,300 in FY 2022 for staff. Other
State agencies can likely carry out the study, training, and reporting requirements with
existing resources, as discussed below. Any expense reimbursements are anticipated to be
minimal and absorbable within existing budgeted resources. No direct effect on revenues.
(in dollars) FY 2022 FY 2023 FY 2024 FY 2025 FY 2026
Revenues $0 $0 $0 $0 $0
GF Expenditure 61,300 71,600 73,800 76,400 79,100
Net Effect ($61,300) ($71,600) ($73,800) ($76,400) ($79,100)
Note:() = decrease; GF = general funds; FF = federal funds; SF = special funds; - = indeterminate increase; (-) = indeterminate decrease
Local Effect: None.
Small Business Effect: None.
Analysis
Bill Summary: The commission must:
assist in the identification of any State program or service that affects children,
youth, families, and older adults;
assist in the development of a statewide strategy toward an organizational culture
shift into a trauma-responsive State government;
establish metrics to evaluate and assess the progress of the statewide
trauma-informed care initiative;
coordinate and develop any formal or informal trauma-informed care training;
disseminate information among agencies regarding best practices for preventing and
mitigating the effect of trauma on children, youth, families, and older adults;
advise and assist the Governor in providing oversight and accountability in
implementing the bill’s requirements;
submit a report using the commission’s established evaluation and assessment
metrics; and
make recommendations regarding improvements to existing laws relating to
children, youth, families, and older adults in the State.
By June 30 of each year, the commission must report its findings and recommendations to
the Governor and the General Assembly.
In consultation with the Maryland Department of Health (MDH), DHS, and the Maryland
Health Care Commission, the commission must (1) study developing a process and
framework for implementing an ACEs Aware program in the State and (2) implement the
program. The purpose of ACEs Aware is to screen for ACEs and toxic stress to provide
targeted, evidence-based interventions to support individual and family health. As part of
the study, the commission must (1) propose a process to set up training and an accreditation
process for program providers and (2) explore the possibility of third-party reimbursement
for screenings under the program. By October 1, 2022, and annually thereafter, the
commission must report its findings and recommendations regarding the development and
implementation of an ACEs Aware program to the Governor and General Assembly.
The bill defines “formal training” as a didactic course or curriculum in trauma-informed
care that is developed by the U.S. Department of Health and Human Services or MDH and
provided by MDH or its designee. Each member of the commission must participate in at
least one formal training each year. In addition, each State agency represented on the
commission must designate two staff members to participate in at least one formal training
each year and carry out other specified responsibilities related to enhancing
trauma-responsiveness in the State.
SB 299/ Page 2
MDH must provide technical advisory support to designated agency staff in carrying out
their duties. By March 31 of each year, each agency director must submit a progress report
to the commission detailing the agency’s progress and compliance in carrying out the bill’s
requirements.
Current Law: Section 7-427.1 of the Education Article defines “trauma-informed
approach” as a method for understanding and responding to an individual with symptoms
of chronic interpersonal trauma or traumatic stress. It requires the Maryland State
Department of Education, in consultation with MDH and DHS, to develop guidelines on a
trauma-informed approach to assist schools with implementing a trauma-informed
approach, as specified.
State Fiscal Effect: GOCPYVS cannot provide ongoing support to the commission with
existing staff. Therefore, general fund expenditures increase by $61,324 in fiscal 2022,
which accounts for a 90-day start-up delay from the bill’s July 1, 2021 effective date. This
estimate reflects the cost of hiring a program manager to provide staff support to the
commission and coordinate the work of member agencies. It includes a salary, fringe
benefits, one-time start-up costs, and ongoing operating expenses.
Position 1.0
Salary and Fringe Benefits $55,743
Operating Expenses 5,581
Total FY 2022 State Expenditures $61,324
Future year expenditures reflect a full salary with annual increases and employee turnover
and ongoing operating expenses.
This estimate assumes MDH can provide the additional support to designated agency staff
with existing resources. MDH advises that it may require as many as three additional staff
to advise the commission regarding the ACEs Aware program. However, as primary
responsibility for staffing the commission rests with GOCPYVS, it is assumed that MDH
can carry out any advisory role with existing resources, especially since ACEs Aware is an
established program operating in California.
This analysis further assumes that MDH does not develop the required formal training but
that existing formal training is used and minimal effort is necessary to train commission
members and designated staff. Otherwise, general fund expenditures also increase for
MDH.
Although the bill requires the commission to implement an ACEs Aware program, this
analysis does not reflect any costs for implementation as any such costs are dependent on
how the commission elects to do so. However, if implementation is similar to California
SB 299/ Page 3
(which provides ACEs screening of children and adults enrolled in Medicaid), Medicaid
expenditures (general and federal funds) increase significantly (with a corresponding
increase in federal revenues).
Additional Information
Prior Introductions: SB 918 of 2020, a similar bill, passed the Senate with amendments
and received a hearing in the House Health and Government Operations Committee, but
no further action was taken.
Designated Cross File: HB 548 (Delegate R. Lewis) - Health and Government
Operations.
Information Source(s): Governor’s Office of Crime Prevention, Youth, and Victim
Services; Maryland Department of Aging; Maryland State Department of Education;
Maryland Department of Health; Department of Budget and Management; Maryland
Department of Disabilities; Department of General Services; Department of Housing and
Community Development; Department of Human Services; Department of Juvenile
Services; Department of State Police; Department of Legislative Services
Fiscal Note History: First Reader - February 5, 2021
rh/jc Third Reader - March 29, 2021
Revised - Amendment(s) - March 29, 2021
Analysis by: Michael C. Rubenstein Direct Inquiries to:
(410) 946-5510
(301) 970-5510
SB 299/ Page 4
Statutes affected: Text - First - Human Services - Trauma-Informed Care - Commission and Training: 81-301 [], 81-302 [], 81-303 [], 81-304 [], 81-305 [], 81-306 [], 81-307 [], 81-308 [], 81-309 [], 81-310 []
Text - Third - Human Services - Trauma-Informed Care - Commission and Training (Healing Maryland's Trauma Act): 81-301 Human Services, 81-302 Human Services, 81-303 Human Services, 81-304 Human Services, 81-305 Human Services, 81-306 Human Services, 81-307 Human Services, 81-308 Human Services, 81-309 Human Services, 81-310 Human Services