TN Advisory Commission on Intergovernmental Relations

Meeting Date: June 18, 2026

Focus Topic Ambulance Services

PC413

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.

63 Counties Provide Service Directly (County / Hospital) 66%

32 Counties Contract Externally (City, Non-Profit, For-Profit) 34%

Average Expenditure Trends

(Excluding operational outliers)

Previous Average $1.8M

Current Average $2.7M

Significant 50% cost escalation noted across operations.

Cities' Participation

11 Cities operate completely independent municipal ambulance services. Others actively assist counties via direct funding injections or shared logistical facilities.

Double Taxation Issue

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.

Workforce Cap

Law limits training centers to 30. Providers urgently demand this cap be lifted/raised to fight aggressive EMS staffing shortages.

State Support

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

General Consensus

"Multiple commission members heavily emphasized the severe structural underfunding and escalating unfunded mandates weighing on local county budgets."

Mayor Frank (Floor Comments)

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.

Tennessee Ambulance Service Association (TASA)
540 W. Main St. #131 • Gallatin, TN 37066
secretary@tennesseeambulance.com • Contact Us

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