Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Colleen Chawla, Chief, San Mateo County Health
Tamarra Jones, Director, Public Health, Policy and Planning
Subject: Public Health, Policy and Planning Fee Schedule Update
RECOMMENDATION:
title
Adopt a resolution updating the Public Health, Policy and Planning (PHPP) Fee Schedule effective July 1, 2026.
body
BACKGROUND:
The PHPP Fee Schedule sets fees for the Public Health Laboratory (PHL), Public Health Clinics, and Vital Records. Services include clinical and environmental testing, vaccines, medical care, vital records documents, and medical marijuana identification cards.
Fees are based on the cost of providing services and are set to avoid creating a barrier to communicable disease testing. Fees are charged to customers (which include individuals and health care providers) who request the service where insurance billing isn’t available. Fees for courier services are charged to requesting agencies or regulated entities, not to individual patients. In addition, fees may be waived for people at risk of spreading a communicable disease, those who qualify under the Federal Health Care for the Homeless Program, or those with economic hardship.
DISCUSSION:
The Fee Schedule is updated each year to add new services, remove outdated fees, and reflect current costs. A cost-based method keeps fees transparent and financially sound. Fees do not exceed the cost of the service. FY 2026-27 changes to fees and methods used to determine the fees are as follows:
Public Health Clinics fees are determined by order pricing from our primary supplier via San Mateo Medical Center and compared with neighboring institutions. Lab test fees for tests performed by the PHL are matched to the PHL fee schedule. STI clinic visit fees are increasing from $25 to $40, which is consistent with peer county STI clinic rates and remain below those charged at comparable retail health settings. Fees generally apply to individuals who are self-pay or with private insurance that PHPP is not able to bill. Clinic fees are kept consistent with one another; patients with Medi-Cal, Ryan White coverage, or a qualifying fee waiver are not charged. PrEP services are being added to the fee schedule to extend access beyond current Health Plan of San Mateo Medi-Cal enrollment, allowing PHPP to serve individuals with other insurance or who seek care outside the primary care system. This change also helps offset the cost of the clinic pharmacist position supporting PrEP initiation and monitoring. Individuals with financial need may access assistance programs for laboratory and medication costs.
PHL clinical testing fees are aligned with the Centers for Medicare and Medicaid Services' 2026 Clinical Laboratory Fee Schedule. Measles RT-PCR testing has been added in response to the worldwide outbreak to reduce turnaround time, support timely case confirmation, and enable prompt reporting to public health authorities.
PHL environmental testing fees are calculated by allocating annual lab expenditures based on staff time, test kit pricing, supply categories, and test volumes. Fees are increasing by 3%, consistent with the regional Consumer Price Index, to reflect rising inflation and labor costs. Weekend pricing has been standardized at double the weekday rate, clarifying previously inconsistent rates without introducing a new premium.
The Nondiagnostic General Health Assessment Program (NGHAP) annual registration fee is increasing from $100 to $300. NGHA providers offer screening tests-such as cholesterol or glucose checks-to asymptomatic individuals to identify potential chronic conditions. NGHA providers are required to register with the local public health laboratory. A review of comparable California counties shows that most charge an annual fee plus per-event or per-test fees. The proposed flat $300 annual fee with no per-event charge improves cost recovery while maintaining a simple structure for registrants.
Courier charges have been reinstated to recover a recurring operational cost previously absorbed without reimbursement. With approximately 75,000 annual test orders requiring secure specimen transport, this change supports long-term financial sustainability.
Vital Records fees are mandated by the California Department of Public Health, with part going to the State Registrar and the remainder to the Vital Records program.
PHPP also requests that the Board authorize the Chief of San Mateo County Health or designee to: (1) add or replace tests already on the Fee Schedule with equivalent tests, as long as the new fee is no more than 10% higher than the current fee; and (2) add tests providing greater clinical information, provided fees are no more than 10% above the highest fee in that category.
The County Attorney's Office has reviewed and approved the resolution as to form.
It is anticipated that 75,000 clinical and environmental PHL test orders will be completed on behalf of the public.
PERFORMANCE MEASURE:
|
Measure |
FY 2025-26 Estimated |
FY 2026-27 Projected |
|
Number of clinical and environmental PHL test orders completed on behalf of the public |
75,000 test orders |
75,000 test orders |
COMMUNITY IMPACT:
The Fee Schedule is designed to keep healthcare and environmental testing available to all county residents, including those from the most vulnerable communities. Fees may be waived for people who qualify under the Federal Health Care for the Homeless Program, those at risk of spreading a sexually transmitted or communicable disease, or those facing economic hardship. For PHL testing, hardship waivers are also available on request. For PrEP services, clinic staff can help people with financial need connect to prevention programs that may cover lab and medication costs.
This approach supports equitable access to preventive and diagnostic care across diverse populations.
FISCAL IMPACT:
The fee changes are expected to increase PHPP revenue by approximately $6,740 annually and will be included in the PHPP FY 2026-27 Adopted Budget. There is no Net County Cost associated with approval of this Fee Schedule.