DATE: May 6, 2025
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Amendment to Master Schedule of Fees, Charges, and Recovered Costs
RECOMMENDED ACTION(S):
TITLE
Conduct second hearing to amend the Master Schedule of Fees, Charges, and Recovered Costs Ordinance by amending Section 2100 - Public Health, subsections 2102 and 2107 (the Ordinance); and waive reading of the Ordinance in its entirety; and adopt proposed Ordinance.
REPORT
There is no increase in Net County Cost associated with the recommended actions. Approval of the recommended actions will revise Section 2100 - Public Health of the Master Schedule of Fees, Charges and Recovered Costs (MSF) Ordinance, last amended 2017-18, to enable full cost recovery, delete inapplicable rates, reduce where necessary, or adjust when related to added services. This item is countywide.
ALTERNATIVE ACTION(S):
Your Board may direct staff to not change the rates, change a portion of the rates, or propose alternative rates; however, these alternatives will not recover the full costs of services.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. It is anticipated the proposed fee increases, if approved by your Board, will allow the recovery of the full costs of Infectious Materials Inspections and Permits, as well as providing paramedic training and certification or accreditation of EMTs, paramedics, base hospital physicians, Emergency Medical Services (EMS) dispatchers, and Mobile Intensive Care Nurses (MICNs). For subsection 2107, fees have increased from 20%-183% for certifications and accreditations, normalizing the fees across certification type, and decreased 11% for paramedic training tuition.
DISCUSSION:
On April 22, 2025, your Board conducted the first hearing for the recommended updates to the MSF for Section 2100 - Public Health. All rates were approved as recommended and are identified in Exhibit A.
On January 9, 2024, your Board adopted Ordinance 24-002 to address the lack of federal regulation for laboratories that do not fall under current federal regulations. The Ordinance provides authority for the County to conduct onsite visits on private property and evaluate if laboratories that are not regulated by Clinical Laboratory Improvement Amendments (CLIA), 42 USC 263a and 42 CFR 493 and are not in compliance with Hazardous Materials laws and general applicable clinical laboratory safety requirements (e.g. medical waste, environmental controls, policy and procedures). The Department would operationalize a team from its Hazardous Materials program and its Public Health Laboratory. This team would conduct annual onsite visits to confirm compliance with Hazardous Materials and laboratory operations. On March 19, 2024, the Board authorized entering into Memorandum of Understandings with incorporated cities to conduct oversight of non-CLIA laboratories.
The Department is returning to your Board upon evaluating the estimated costs that will be recovered for these activities. Given that a fee study cannot be conducted due to the fact that there are currently no regulations or inspections imposed on Non-CLIA laboratories or businesses, the Department has proposed new fees to subsection 2102 of Section 2100 of the Master Schedule of Fees. The rates were developed based on the best estimates at this time. If revisions are needed based on actual costs from experience, the Department anticipates retuning to your Board. The methodology for calculating the proposed fees has been reviewed and approved by the Auditor-Controller/Treasurer-Tax Collector.
The recommended rates in Exhibit A consist of applicable direct and indirect salaries, benefits, services and supplies, including departmental and countywide overhead costs. Attachment A provides detail of the changes proposed to the existing rates for comparative purposes, which includes revised, reduced, increased, and deleted fees as well as the addition of new fees. The last time these Public Health fees were updated was FY 2017-18.
The proposed amendment to Section 2100 is recommended to recover 100% direct and indirect costs for services. The Department completed its Public Health Fee Study for EMS certification, accreditation, and training in subsection 2107 in 2025. In November 2024 through January 2025, the Auditor-Controller/Treasurer-Tax Collector reviewed and approved the methodology and calculation of the permit rates.
The recommended rates, including their calculation, and the methodology applied for cost recovery, has been reviewed and approved by the Auditor-Controller/Treasurer Tax-Collector.
If adopted by your Board, the proposed rates will take effect on June 5, 2025, 30 days after the passing of the proposed ordinance and will subsequently begin billing as appropriate.
REFERENCE MATERIAL:
BAI #11, April 22, 2025
BAI #47, March 19, 2024
BAI #41, January 9, 2024
ATTACHMENTS INCLUDED AND/OR ON FILE:
MSF Attachment A
MSF Ordinance
CAO ANALYST:
Ronald Alexander