Title 9 — SUBCONTRACTOR TRANSPARENCY IN COUNTY PERMITS (CLEAN

Article XV — B HEALTH AND HUMAN SERVICES CHARGES AND FEES

San Diego County Municipal Code · 2026-09 edition · updated 2026-10-02 · San Diego County

*Editor’s note -- Article XV-B, Health and Human Services Charges and Fees, §§ 238--248.3, added by Ord. No. 8835 (N.S.), effective 11-6-97.

SEC. 238. RESPONSIBILITY FOR COST.

Except as otherwise provided by law or by contract all aid rendered shall be a charge against the patient, the patient’s spouse, or the patient’s parents when the patient is a minor, and they shall be jointly and severally liable to pay the costs thereof. Parents shall not be liable for care of children 15 years of age or older living separate and apart from the parents and managing their own financial affairs unless such parents have requested or consented to such care of their child or children. The Agency Director or designated representative, and the Director of Revenue and Recovery, or designated representative, are hereby authorized to use appropriate means to collect repayment of costs from patients and responsible relatives, including securing payment by requiring execution and filing of liens consistent with Welfare & Institutions Code section 17109 and any other applicable statutory provisions.

(Added by Ord. No. 9704 (N.S.), effective 3-10-05; amended by Ord. No. 9920 (N.S.), effective 4-10-08; amended by Ord. No. 10477 (N.S.), effective 5-25-17; amended by Ord. No. 10532 (N.S.), effective 5-24-18; amended by Ord. No. 10600 (N.S.), effective 5-30-19)

SEC. 238.1. BEHAVIORAL HEALTH SERVICES.¶

Effective July 1, 2026, any duty or authority assigned in this Article to the Health and Human Services Agency or its Director shall, with respect to behavioral health fees or charges, or for facilities operated by the Behavioral Health Services Department, be assigned to the Behavioral Health Services Department or the Director of Behavioral Health Services, as applicable.

(Added by Ord. No. 10996 (N.S.), effective 6-18-26)

SEC. 239. RATES OF CHARGE IN ACCORDANCE WITH THE PUBLISHED MEDI-CAL SCHEDULE.

Except as otherwise specified in Section 240 through Section 255 of this Administrative Code, the rates of charge for health care to be rendered by public health and behavioral health programs listed in Section 233 of this Administrative Code shall be set in accordance with the current published Medi-Cal schedule and shall be revised by the Agency Director of the Health and Human Services Agency, referred to hereafter in this Article as Agency Director, as the published Medi-Cal

schedule changes. At least once each twenty-four (24) months, the rates shall be reviewed by the Health and Human Services Agency to assure that such charges do not exceed the County's actual costs. In the event the review determines that any specific charge(s) exceed actual costs, the Agency Director shall revise the rates of charge to reduce the applicable charge(s) to the level of actual costs. Specified services subject this section include:

(a) public health services:

(1) Trichomonas test

(2) GC Culture (Negative) test

(3) GC Culture (Positive) test

(4) Norovirus by PCR test

(5) Confirmatory HIV-1/2 (Genius) test

(6) Mycobacteriology Culture (includes Specimen Concentration, Fluorochrome Smear, and MGIT culture)

(7) Mycobacteriology Positive Culture and Identification (includes Specimen Concentration, Fluorochrome Smear, MGIT

culture, Ziehl-Neelsen smear, GeneXpert MTB/Rif, and subculture)

(8) Drug susceptibility, per drug test

(9) Direct specimen PCR for TB/ Rifampin resistance test

(10) Darkfield exam test

(11) RPR - quantitative test

(12) Confirmatory TP-PA with both RPR above test

(13) Syphilis Antibody CIA test

(14) Immunizations provided

(15) Enterovirus

(16) Hepatitis A PCR Screening (Thermocycler)

(17) Measles PCR

(18) Mumps PCR

(19) Herpes NAAT

(20) Measles CIA IgG

(21) Hepatitis A Prep Sequencing

(22) Hepatitis B CORE Antibody (Total)

(23) Hepatitis C Antibody

(24) Hep C RNA

(25) Hepatitis B surface antibody (HbsAg) Quantitative

(26) Hepatitis B surface antigen (HbsAb) Qualitative

(27) HIV-1/2 Antigen/Antibody CIA test

(28) Carbapenem-Resistant A. baumannii (CRAB) - Negative

(29) Carbapenem-Resistant A. baumannii (CRAB) - Positive

(30) MALDI-TOF MOTT

(31) General Bacteriology

(32) MALDI-TOF MS

(33) API Testing

(34) Monkeypox PCR

(35) Other related health services that are included in the Medi-Cal schedule

(b) behavioral health services:

(1) Hospital Inpatient

(2) Hospital Administrative Day

(3) Crisis Stabilization - Urgent Care/ ER

(4) Day Rehabilitation - Full Day

(5) Outpatient Services by Provider type

(6) Other related behavioral health services that are included in the Medi-Cal schedule

(1) Pharmacy Dispensing

(Added by Ord. No. 8835 (N.S.), effective 11-6-97; amended by Ord. No. 9475 (N.S.), effective 7-18-02; amended by Ord. No. 9558 (N.S.), effective 6-20-03; amended by Ord. No. 10477 (N.S.), effective 5-25-17; amended by Ord. No. 10532 (N.S.), effective 5-24-18; amended by Ord. No. 10600 (N.S.), effective 5-30-19; amended by Ord. No. 10722 (N.S.), effective 6-3-21; amended by Ord. No. 10797 (N.S.), effective 7-14-22; amended by Ord. No. 10844 (N.S.), effective 6-22-23; amended by Ord. No. 10900 (N.S.), effective 6-20-24; amended by Ord. No. 10940 (N.S.), effective 6-19-25; amended by Ord. No. 10996 (N.S.), effective 6-18-26)

SEC. 240. PATIENTS‘ ECONOMIC STATUS TO BE DETERMINED.

Except for those persons who pay the established rates of charge in full, the economic status of all patients who seek admission to any of the treatment or custodial facilities where patients are charged will be determined as follows:

(a) Mental Health and Substance Use Disorder cases: In accordance with the State mandated "Uniform Method of Determining Ability to Pay" and California Health and Safety Code 11841."

(b) Prisoners: Those receiving out-patient care will be accepted as financially eligible. Those receiving in- patient care will be checked for applicable third-party coverage.

(c) All others: In accordance with the eligibility procedure used by the State's Medi-Cal Program, or as may otherwise be approved by the Board of Supervisors.

Exceptions & meaning →

SEC. 240.1. NOTICE TO RESPONSIBLE RELATIVES.¶

The Agency Director may cause a written notice to be sent to all responsible relatives of an applicant for admission, which notice shall inform them of their legal liability for the care of such applicant. Upon the request of the Agency Director the responsible relatives shall file within ten (10) days if living in the County, or within thirty (30) days if living elsewhere, under penalty of perjury a form supplying the information essential to the determination of the relatives' liability for support of an applicant or recipient of aid. The Agency Director may authorize and direct any County officers or employees personally to visit those responsible relatives living in the County and to collect from such relatives reimbursement for all care given by the County. Execution of liens may be required of responsible relatives as a condition of withholding legal action, except that no lien shall be taken against the home or other property of any relative, other than a parent of a minor or a spouse, liable for the support of a person receiving County aid or relief.

Exceptions & meaning →

SEC. 240.2. AGENCY DIRECTOR OF THE HEALTH AND HUMAN SERVICES¶

AGENCY OR DIRECTOR OF REVENUE AND RECOVERY MAY DEFER BILLING OR COMPROMISE AND SETTLE AN ACCOUNT.

The Agency Director or designated representative, and the Director of Revenue and Recovery, or designated representative, are hereby authorized to defer billing, or compromise and settle an account when investigation reveals that neither the patient nor the patient's responsible relatives or representative can pay for or otherwise secure the care, or the means for paying for the care, which the patient requires. In making this determination the Agency Director or the Director of Revenue and Recovery will give consideration to:

In mental health cases, the State mandated “Uniform Method of Determining ability to Pay.”
In non-mental health cases:

(a) The nature of the patient's illness, the probable duration of disability, its effect on the patient's future income

production and the probable cost of private care.

(b) The family assets and obligations, their accustomed standard of living and the amount of indebtedness which they

can be expected to assimilate.

Further, the Agency Director or the Director of Revenue and Recovery may compromise and settle an account whenever the Agency Director and the County Counsel agree that actual or potential legal problems arising from the treatment of a case, or collection of an account, indicate such action to be to the best interest of the County.

Exceptions & meaning →

SEC. 240.3. ACTIVATION OF DEFERRED ACCOUNTS.¶

A deferred account will be activated, entered in the books and presented for collection whenever information indicates that the patient and his responsible relatives are able to pay for the services rendered.

Exceptions & meaning →

SEC. 240.4. NON-RESIDENT PATIENTS; BILLING FOR, AND¶

TRANSFERRING.

Whenever a non-resident patient as defined by State law is admitted to an Agency facility, every effort will be made to determine his place of legal residence. No such patient will be found eligible for either a deferred bill or a compromise settlement until all means of securing payment from the authorities at his place of residence have been exhausted and all such patients who are granted deferred or compromise status will be removed from the Agency as soon as other facilities can be found and the patient's condition permits such removal. As to psychiatric patients referred for Mental Health Services, County residence as defined in Welfare and Institutions Code or Health and Safety Code, shall not be required, but state residence as defined in the Government Code is sufficient for the patient's eligibility, deferred billing, or postponement of removal to place of residence.

SEC. 241. ALL PATIENTS TO BE STAFF CASES.

The care and treatment of all patients admitted to any health care institution or program operated by the Agency shall be supervised and administered only by qualified professionals who are either employed by the Agency or regularly appointed and assigned as a member of the staff of a division of the Agency.

SEC. 242. [RESERVED.]

(Added by Ord. No. 8835 (N.S.), effective 11-6-97; amended by Ord. No. 9475 (N.S.), effective 7-18-02; amended by Ord. No. 9558 (N.S.), effective 6-20-03; repealed by Ord. No. 10477 (N.S.), effective 5-25-17)

SEC. 243. FEE FOR VENEREAL DISEASE SERVICES.

The Agency Director shall charge and collect a fee of $40 from each person receiving venereal disease services from the County. Services provided for said fee shall include the initial examination, diagnosis, treatment, and follow-up for purposes of determining whether the disease has been cured.

SEC. 244. FEES FOR LABORATORY SERVICES.

The Agency Director shall charge and collect the following fees for the following laboratory services:

ENVIRONMENTAL TESTING FEES Colilert for Total Coliforms & E. coli (Drinking Water) $41.38

Enterolert for Enterococcus - 0.1 Dilution (Marine Water) $18.89

Enterolert for Enterococcus - Additional Dilution (Marine Water) $18.24 Enterolert for Enterococcus - Undiluted (Marine Water) $17.57 Membrane Filtration for Enterococcus - Undiluted and 0.1 Dilution $188.14 Membrane Filtration for Enterococcus - Additional Dilution $24.15 Colilert-18 for Total Coliforms & E. coli - Additional Dilution (Marine Water) $20.39 Colilert-18 for Total Coliforms & E. coli - Undiluted (Marine Water) $19.79 Membrane Filtration for Total Coliforms - Undiluted and 0.1 Dilution $102.74 Membrane Filtration for Fecal Coliforms - Undiluted and 0.1 Dilution $67.21 Membrane Filtration for Total Coliforms - Additional Dilution $17.20 Membrane Filtration for Fecal Coliforms - Additional Dilution $18.45 Colilert-18 for Total Coliforms & E. coli - 0.1 Dilution (Marine Water) $21.11 ddPCR for Enterococcus $124.33 ddPCR for Enterococcus (Overtime Rate) $151.07 HF183 by ddPCR - Replicate $84.73 Enterolert for Enterococcus - Base Cost (Marine Water) $24.42 Colilert-18 for Total Coliforms & E. coli - Base Cost (Marine Water) $26.48 Water Sample Filtration $49.68 Virus Identification by PCR, Influenza test $95.19 OTHER TESTS CURRENTLY PERFORMED Food borne examination (Negative) $150.85 Food borne examination (Positive) $304.77 Rabies $140.81 Save Body Carcass Return $25.00 Rabies Testing Extraction $94.11 OTHER CLINICAL FEES SARS-CoV-2 Assay - Panther Fusion $17.24 SARS-CoV-2 Assay - Panther Aptima $29.43 Biofire GI Panel PCR $220.27 HIV-1 Viral Load $63.12 Hep C RNA $31.19 Chlamydia / Gonorrhea - Panther $22.80 Quantiferon Gold (TB test, cell immune measure) test $42.01 Panther Fusion - 4plex test (SARS, Influenza A&B and RSV) $34.24 NON-DIAGNOSTIC GENERAL HEALTH ASSESSMENT Semi-annual general filing fee $137.00 Semi-annual fee for additional tests $34.00 Semi-annual fee for additional location $95.00 Annual Maximum Charge per Agency $1,228.00

SEC. 245. WAIVER OF FEES.

The Public Health Officer may waive collection of all or part of the fees provided for in Sections 239, 243, and 244 of this Administrative Code in the event that the Public Health Officer determines that such waiver is in the interest of protecting the public health.

(Added by Ord. No. 8835 (N.S.), effective 11-6-97; amended by Ord. No. 9160 (N.S.), effective 7-20-00; amended by Ord. No. 9475 (N.S.), effective 7-18-02; amended by Ord. No. 9558 (N.S.), effective 6-20-03; amended by Ord. No. 10477 (N.S.),

effective 5-25-17; amended by Ord. No. 10532 (N.S.), effective 5-24-18; amended by Ord. No. 10600 (N.S.), effective 5-30- 19)

SEC. 246. [RESERVED.]

(Added by Ord. No. 8835 (N.S.), effective 11-6-97; amended by Ord. No. 9475 (N.S.), effective 7-18-02; amended by Ord. No. 9558 (N.S.), effective 6-20-03; amended by Ord. No. 9704 (N.S.), effective 3-10-05; amended by Ord. No. 9992 (N.S.), effective 7-23-09; amended by Ord. No. 10477 (N.S.), effective 5-25-17; amended by Ord. No. 10532 (N.S.), effective 5-24- 18; amended by Ord. No. 10600 (N.S.), effective 5-30-19; amended by Ord. No. 10722 (N.S.), effective 6-3-21; repealed by Ord. No. 10754 (N.S.), effective 12-2-21)

SEC. 247. [RESERVED.]

SEC. 248. TARGETED CASE MANAGEMENT SERVICES FEES - HEALTH AND HUMAN SERVICES AGENCY.

(a) The Agency Director shall charge and collect a fee established in accordance with the State Targeted Case Management (TCM) Cost Plan process for Public Health Nursing Targeted Case Management Services. The fees to be charged shall be calculated as a percentage of the cost of services as provided in the following fee schedules based on the family size and adjusted gross income of the party liable for the fee:

FEE SCHEDULE - INDIVIDUAL OR FAMILY OF TWO

For families of one or two persons, including the client and all members of the same household:

ADJUSTED GROSS INCOME FEE FACTOR

(Amount reported by liable party on most recent (% of the cost of services provided) federal income tax return) ADJUSTED GROSS INCOME FEE FACTOR

(Amount reported by liable party on most recent (% of the cost of services provided) federal income tax return) $ 1 - $ 76,366 0% $ 76,367 - $ 80,663 5% $ 80,664 - $ 86,041 10% $ 86,042 - $ 91,419 15% $ 91,420 - $ 96,797 20% $ 96,798 - $102,174 25% $102,175 - $107,552 30% $107,553 - $112,929 35% $112,930 - $118,307 40% $118,308 - $123,685 45% $123,686 - $129,062 50% $129,063 - $134,440 55% $134,441 - $139,817 60% $137,818 - $145,196 65% $145,197 - $150,573 70% $150,574 - $155,950 75% $155,951 - $161,328 80% $161,329 - $166,706 85% $167,707 - $172,084 90% $172,085 - $177,461 95% $177,462 and over 100%

FEE SCHEDULE - FAMILY OF THREE

For families of three persons, including the client and all members of the family residing in the same household:

ADJUSTED GROSS INCOME FEE FACTOR (Amount reported by liable party on most recent federal income tax return) (% of the cost of services provided)

ADJUSTED GROSS INCOME FEE FACTOR

(Amount reported by liable party on most recent (% of the cost of services provided) federal income tax return) $ 1 - $112,929 0% $112,930 - $118,307 5% $118,308 - $123,685 10% $123,686 - $129,062 15% $129,063 - $134,440 20% $134,441 - $139,817 25% $139,818 - $145,196 30% $145,197 - $150,573 35% $150,574 - $155,950 40% $155,951 - $161,328 45% $161,329 - $166,706 50% $166,707 - $172,084 55% $172,085 - $177,461 60% $177,462 - $182,839 65% $182,840 - $188,216 70% $188,217 - $193,594 75% $193,595 - $198,972 80% $198,973 - $204,349 85% $204,350 - $209,727 90% $209,728 - $215,104 95% $215,105 and over 100%

FEE SCHEDULE - FAMILY OF FOUR

For families of four or more persons, including the client and all members of the family residing in the same household:

ADJUSTED GROSS INCOME FEE FACTOR

(Amount reported by liable party on most recent (% of the cost of services provided) federal income tax return) ADJUSTED GROSS INCOME FEE FACTOR

(Amount reported by liable party on most recent (% of the cost of services provided) federal income tax return) $ 1 - $145,196 0% $145,197 - $150,573 5% $150,574 - $155,950 10% $155,951 - $161,328 15% $161,328 - $166,706 20% $166,707 - $172,084 25% $172,085 - $177,461 30% $177,462 - $182,839 35% $182,840 - $188,216 40% $188,217 - $193,594 45% $193,595 - $198,972 50% $198,973 - $204,349 55% $204,350 - $209,727 60% $207,728 - $215,104 65% $215,105 - $220,483 70% $220,484 - $225,860 75% $225,861 - $231,237 80% $231,238 - $236,615 85%

$236,616 - $241,993 90%

$241,994 - $247,371 95% $247,372 and over 100%

(b) The Agency Director shall charge and collect the following fees for conservatorship services in the Lanterman-Petris- Short (“LPS”) Conservatorship Program. The Agency Director may authorize his or her designee to charge and collect the fees specified in this subdivision. The fees to be charged shall be as follows:

End of Month Balance in Client Reserve Account Annual Fee End of Month Balance in Client Reserve Account Annual Fee $ 0 - $ 2,000 $ 0 $ 2,001 - $ 2,500 $ 100 $ 2,501 - $ 3,000 $ 200 $ 3,001 - $ 3,500 $ 300 $ 3,501 - $ 4,000 $ 400 $ 4,001 - $ 4,500 $ 500 $ 4,501 - $ 5,000 $ 600 $ 5,001 - $ 5,500 $ 700 $ 5,501 - $ 6,000 $ 800 $ 6,001 - $ 6,500 $ 900 $ 6,501 - $ 7,000 $1,000 $ 7,001 - $ 7,500 $1,100 $ 7,501 - $ 8,000 $1,200 $ 8,001 - $ 8,500 $1,300 $ 8,501 - $ 9,000 $1,400 $ 9,001 - $ 9,500 $1,500 $ 9,501 - $10,000 $1,600 $10,001 and up $1,700

SEC. 249. [RESERVED.]

(Added by Ord. No. 9394 (N.S.), effective 11-8-01; amended by Ord. No. 9475 (N.S.), effective 7-18-02; amended by Ord. No. 9558 (N.S.), effective 6-20-03; repealed by Ord. No. 9704 (N.S.), effective 3-10-05)

SEC. 250. [RESERVED.]

(Added by Ord. No. 9717 (N.S.), effective 7-1-05; amended by Ord. No. 9771 (N.S.), effective 6-8-06; amended by Ord. No. 9992 (N.S.), effective 7-23-09; amended by Ord. No. 10355 (N.S.), effective 10-23-14; amended by Ord. No. 10477 (N.S.), effective 5-25-17; amended by Ord. No. 10532 (N.S.), effective 5-24-18; amended by Ord. No. 10600 (N.S.), effective 5-30- 19; amended by Ord. No. 10722 (N.S.), effective 6-3-21; repealed by Ord. No. 10754 (N.S.), effective 12-2-21)

SEC. 251. [RESERVED.]

(Amended by Ord. No. 10722 (N.S.), effective 6-3-21; repealed by Ord. No. 10754 (N.S.), effective 12-2-21)

SEC. 252. OFFICE OF VITAL RECORDS AND STATISTICS - FEE FOR STATE MANDATED MEDICAL MARIJUANA IDENTIFICATION CARD PROGRAM.

The Agency Director shall charge and collect for the State Mandated Medical Marijuana Identification Card up to the amount authorized in the California Health and Safety Code.

(Added by Ord. No. 9995 (N.S.), effective 8-20-09; amended by Ord. No. 10477 (N.S.), effective 5-25-17; amended by Ord. No. 10532 (N.S.), effective 5-24-18; amended by Ord. No. 10600 (N.S.), effective 5-30-19)

SEC. 253. VITAL RECORDS NON-CONTAGIOUS DISEASE LETTER.

The Agency Director shall charge and collect the following fee for a Non-Contagious Disease Letter: $14.00

(Ord. No. 10152 (N.S.), effective 7-14-11; amended by Ord. No. 10355 (N.S.), effective 10-23-14; amended by Ord. No. 10477 (N.S.), effective 5-25-17; amended by Ord. No. 10532 (N.S.), effective 5-24-18; amended by Ord. No. 10600 (N.S.), effective 5-30-19; amended by Ord. No. 10722 (N.S.), effective 6-3-21; repealed by Ord. No. 10754 (N.S.), effective 12-2- 21; new Section 253 added by Ord. No. 10996 (N.S.), effective 6-18-26)

SEC. 254. [RESERVED.]

SEC. 255. EDGEMOOR DISTINCT PART SKILLED NURSING FACILITY.

The Agency Director shall charge and collect the following fees for the following inpatient health services at Edgemoor Distinct Part Skilled Nursing Facility:

Private Pay Rate $1,119

(Added by Ord. No. 10477 (N.S.), effective 5-25-17; amended by Ord. No. 10532 (N.S.), effective 5-24-18; amended by Ord. No. 10600 (N.S.), effective 5-30-19; amended by Ord. No. 10722 (N.S.), effective 6-3-21; amended by Ord. No. 10797 (N.S.), effective 7-14-22; amended by Ord. No. 10844 (N.S.), effective 6-22-23; amended by Ord. No. 10900 (N.S.), effective 6-20-24; amended by Ord. No. 10940 (N.S.), effective 6-19-25; amended by Ord. No. 10996 (N.S.), effective 6-18-26)

SEC. 256. TOBACCO RETAIL LICENSING PROGRAM.

The Agency Director shall charge and collect the following fees for Tobacco Retail Licensing Program: $730.00

(Added by Ord. No. 10797 (N.S.), effective 7-14-22; amended by Ord. No. 10844 (N.S.), effective 6-22-23; amended by Ord. No. 10940 (N.S.), effective 6-19-25)

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