Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Tamarra Jones, Director, Public Health, Policy, and Planning
Subject: Public Health, Policy, and Planning Fee Schedule Update
RECOMMENDATION:
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Adopt a resolution updating the Public Health, Policy, and Planning Fee Schedule effective July 1, 2024.
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BACKGROUND:
The San Mateo County Public Health, Policy, and Planning Fee Schedule (Fee Schedule) includes fees charged by the Public Health Laboratory (PHL), Public Health Clinics, and Vital Statistics. Fee-based services include, clinical and environmental testing, vaccines, medical services, birth and death certificates, and Medical Marijuana identification cards.
The fees charged are determined by considering the cost of providing services and the need to prevent fees from becoming a barrier to testing for communicable diseases. Some fees may be waived for persons determined to be at risk for transmitting a communicable disease on to others.
DISCUSSION:
The Fee Schedule is updated annually to add fees for new services, eliminate fees that are no longer necessary, and align fees with changing costs. A cost-based methodology is used for transparency and to help Public Health, Policy, and Planning (PHPP) determine the financial viability of services. The fees do not exceed the cost of providing the product or the service of enforcing the regulation for which the fees are levied. The methods used to determine the fees for each program are as follows:
Health Clinic fees are determined by historical benchmarking. Some immunization fees are based on materials provided by external agencies. Fees for lab tests provided by the PHL are matched to the PHL fee schedule.
PHL clinical testing fees have been changed to align with the Centers for Medicare and Medicaid Services’ 2024 Clinical Laboratory Fee Schedule. PHL environmental testing fees were calculated by allocating annual lab expenditures based on staff time to complete each test, the price of test kits, the category of test for which supplies are used, and the volumes for each test. Individual tests of public health importance may be discounted by the Health Officer or PHL director.
Vital Statistics fees are mandated by the California Department of Public Health, with some portion going to the State Registrar and the remainder to the Vital Statistics program.
Based on historical client volumes, the total fees projected to go to the PHPP programs mentioned above for FY 2024-25 are at or below total expenditures.
PHPP further requests this Board to authorize the Chief of San Mateo County Health or designee to make changes to the Fee Schedule to replace tests for diseases that are already included on the approved Fee Schedule with an equivalent test, as long as the new test fee is no more than 10% greater than the current test fee; and to add tests that provide a greater level of clinical information than current tests, as long as these fees are no more than 10% greater than the highest fee in that category (e.g. Laboratory Fees, Respiratory Disease Tests, etc.).
The County Attorney’s Office has reviewed and approved the Resolution as to form.
It is anticipated that 58,000 clinical and environmental PHL test orders will be completed on behalf of the public.
PERFORMANCE MEASURE:
|
Measure |
FY 2023-24 Estimated |
FY 2024-25 Projected |
|
Number of clinical and environmental PHL test orders completed on behalf of the public |
56,500 test orders* |
58,000 test orders |
*As of May 6th, 2024
EQUITY IMPACT:
The PHPP fee schedule for healthcare and environmental tests takes into account the financial barriers of residents (or lab users) from the County’s most vulnerable communities. Fees may be waived for any person meeting eligibility criteria under the Federal Health Care for the Homeless Program and/or for persons clinically determined to be at risk for transmitting a sexual transmitted disease or communicable disease to others. For Public Health Lab testing, fee waivers are also available upon request due to economic hardship.
The approach described above helps maintain equitable access to preventative and diagnostic healthcare and environmental testing across diverse populations.
FISCAL IMPACT:
The changes to the PHPP fees are minimal and are expected to generate no additional revenue in FY 2024-25. These funds have been included in the PHPP FY 2024-25 Recommended Budget. There is no Net County Cost associated with the approval of this Fee Schedule.