The following is a summary of what was noted during the June 18, 2026 TN Advisory Commission on Intergovernmental Relations:
TN Advisory Commission on Intergovernmental Relations
Meeting Date: June 18, 2026
Legislative Directive
Mandate: Public Chapter 413 (Acts of 2025)
Statutory directive to study the economic impact on counties required to provide ambulance services, evaluate how cities/municipalities participate, and address systemic funding and reimbursement issues.
Key Findings & Data
County Responsibility Breakdown
All 95 TN counties are legally mandated to ensure at least one licensed ambulance service.
Average Expenditure Trends
(Excluding operational outliers)
11 Cities operate completely independent municipal ambulance services. Others actively assist counties via direct funding injections or shared logistical facilities.
Original bill elements (SB160 / HB83) proposed forcing cities to reimburse counties up to 50% of service costs.Commission & stakeholders strongly oppose this, warning it promotes system fragmentation.
Law limits training centers to 30. Providers urgently demand this cap be lifted/raised to fight aggressive EMS staffing shortages.
Current nonrecurring equipment grants are volatile and non-guaranteed. Transitioning to recurring funding is recommended for long-term planning stability.
Operational Adjustments
Cost-Reducing & Revenue-Increasing Alternatives
Third-Party Billing Companies
Deploy expert vendor billing integration to markedly optimize collections and cash flow.
Expanded Transport Options
Broaden non-emergency services to capture critical strategic insurance and patient reimbursements.
Shared Medical Directors
Pool regional resources across multiple agencies to heavily reduce top-tier overhead costs.
TNT2 Program Optimization
Maximize utilization of state-level alternative dest./treat-in-place Medicaid reimbursements.
Commission Recommendations
Reject Mandatory Cost-Sharing
Do NOT implement the forced 50% city/county cost-sharing written in SB160/HB83. Prioritize voluntary, localized cooperative arrangements.
Secure Recurring Equipment Grants
Formally transition volatile EMS equipment grants into a reliable, permanent recurring line item within the state budget.
De-cap Training Centers
Lift or aggressively raise the current statutory limit of 30 service-operated training facilities to mitigate workforce shortages.
Promote Advanced Revenue Toolkits
Directly encourage local EMS agencies to aggressively leverage billing innovations and alternative state health care program channels.
Floor Discussion Notes
“Multiple commission members heavily emphasized the severe structural underfunding and escalating unfunded mandates weighing on local county budgets.”
Expressed strong interest in exploring emerging modern EMS operational models, noting that they require systematic evaluation and legislative adaptations.
Requested the final formal report explicitly amplify specific recommendations or aggressively isolate the urgent need for comprehensive policy corrections at both state and federal levels.