SB 425
Department of Legislative Services
Maryland General Assembly
2021 Session
FISCAL AND POLICY NOTE
Third Reader - Revised
Senate Bill 425 (Senator Augustine)
Finance Health and Government Operations and
Ways and Means
Workgroup on Screening Related to Adverse Childhood Experiences
This bill establishes a Workgroup on Screening Related to Adverse Childhood
Experiences. The Maryland Department of Health (MDH) must provide staff for the
workgroup. A member of the workgroup may not receive compensation but is entitled to
reimbursement for expenses under standard State travel regulations. The workgroup must
submit a report of its findings and recommendations to the Governor and the
General Assembly by October 1, 2022. The bill terminates September 30, 2023.
Fiscal Summary
State Effect: MDH general fund expenditures increase by at least $62,500 in FY 2022
and $17,400 in FY 2023 for contractual staff support. Reimbursements for workgroup
members are assumed to be minimal and absorbable within existing budgeted resources.
Revenues are not affected.
(in dollars) FY 2022 FY 2023 FY 2024 FY 2025 FY 2026
Revenues $0 $0 $0 $0 $0
GF Expenditure 62,500 17,400 0 0 0
Net Effect ($62,500) ($17,400) $0 $0 $0
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 workgroup must:
 update, improve, and develop screening tools for primary care providers to identify
and treat minors who have a mental health disorder that may be caused by or related
to an adverse childhood experience;
 submit the screening tools to MDH;
 recommend changes to the physical examination form that the Maryland State
Department of Education (MSDE) requires for all new students entering a public
school;
 study and make recommendations on the actions a primary care provider should
take following the use of the developed screening tool;
 study best practices in Youth Risk Behavior Survey (YRBS) data summaries and
trends reports nationally;
 develop a YRBS template for a State- and county-level data summary and trends
report that includes specified information;
 make recommendations for improving YRBS and the Youth Tobacco Survey (YTS)
and the surveys’ data and trends reports, including specified items; and
 develop recommendations for unifying and coordinating child- and family-serving
agencies to better link them with needed interventions and services.
Current Law: A physical examination is required of each child entering the Maryland
public school system for the first time. The examination must be completed within a
15-month period, specifically within 9 months before entrance or 6 months after entrance.
The physical examination form designated by MSDE and MDH must be used to meet this
requirement. The physical examination must be completed by a physician or a certified
nurse practitioner.
The Maryland YRBS/YTS is an on-site survey of students in Maryland public middle and
high schools, focusing on behaviors that contribute to the leading causes of death and
disability, including but not limited to, alcohol and other drug use, tobacco use, sexual
behaviors, unintentional injuries and violence, and poor physical activity and dietary
behaviors. Questions on YRBS and YTS are generated by the U.S. Centers for Disease
Control and Prevention and required to be administered in public middle and high schools
across the state. MDH and MSDE jointly administer the surveys. Statewide and
county-level data from YRBS/YTS (most recently administered during the
2018-2019 school year) is available on MDH’s Prevention and Health Promotion
Administration website.
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State Expenditures: Based on an analysis of similar legislation from 2020, MDH
general fund expenditures increase by at least $62,475 in fiscal 2022, which accounts for
the bill’s October 1, 2021 effective date. This estimate reflects the cost of hiring
one advanced health policy analyst to staff the workgroup and prepare the required report.
It includes a salary, fringe benefits, and one-time start-up costs.
FY 2022 FY 2023
Contractual Position 1.0 (1.0)
Salary and Fringe Benefits $56,894 $17,218
Operating Expenses 5,581 164
Total MDH Administrative Expenditures $62,475 $17,382
Fiscal 2023 expenditures reflect annual increases and employee turnover, ongoing
operating expenses, and elimination of the contractual position on October 1, 2022,
concurrent with the due date for the workgroup’s report.
This estimate does not include any health insurance costs that could be incurred for
specified contractual employees under the State’s implementation of the federal Patient
Protection and Affordable Care Act.
Additional Comments: Adverse childhood experiences (ACEs) are potentially traumatic
events that occur in a child’s life such as physical or emotional abuse, neglect, caregiver
mental illness or substance abuse, and household violence. In 2017, California established
a workgroup to advise on the appropriate tools and protocols for screening children for
trauma within the state’s Early and Periodic Screening, Diagnostic, and Treatment
Medicaid benefit. A screening tool was developed and, effective January 1, 2020, screening
for ACEs became a covered benefit in California’s Medicaid program for children and
adults up to age 65 (excluding those dually eligible for Medicaid and Medicare).
Additional Information
Prior Introductions: HB 666 of 2020, a similar bill, received a hearing in the House
Health and Government Operations Committee, but no further action was taken.
Designated Cross File: HB 783 (Delegate Queen) - Health and Government Operations
and Ways and Means.
Information Source(s): Maryland State Department of Education; Maryland Department
of Health; Department of Legislative Services
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Fiscal Note History: First Reader - February 11, 2021
rh/ljm Third Reader - March 19, 2021
Revised - Updated Information - March 19, 2021
Analysis by: Jennifer B. Chasse Direct Inquiries to:
(410) 946-5510
(301) 970-5510
SB 425/ Page 4