TACIR Publishes Final Report on Tennessee Ambulance Services

778,299

Emergency calls in 2024
up from 564,600 in 2021

+21%

Average county ambulance expenditures
FY 2021-22 to FY 2023-24

+47%

Average gap between expenditures and collected patient charges
over the same period

Recurring Ambulance Equipment Funding

TACIR recommends that the General Assembly make funding for the existing ambulance equipment grant recurring. The report notes that $5 million was appropriated for ambulance equipment grants in 2025, but the funding was not recurring.

TennCare Reimbursement Pressure

The report warns that recent federal law and proposed federal rule changes could reduce total state-directed payments for emergency transports of TennCare patients by limiting combined payments to 110% of the Medicare rate. TACIR also identifies reimbursement approaches that may remain available, including increasing non-emergency transport reimbursement to 100% of Medicare.

EMS Workforce & Training Capacity

Tennessee currently allows a maximum of 30 EMS training centers. Stakeholders told TACIR that increasing or removing the cap could expand the workforce pipeline. The report notes that first-attempt pass rates were nearly the same for centers established before and after the 2022 increase in the cap—62% and 63%, respectively.

City-County Collaboration

TACIR does not recommend the municipal cost-sharing approach in Senate Bill 160 / House Bill 83 as originally filed. Instead, the Commission encourages counties and cities to continue developing mutually beneficial arrangements to share costs and improve ambulance services.

Options to Increase Revenue or Reduce Costs

The report identifies several strategies ambulance services may consider, including third-party billing, expanding non-emergency transport, sharing medical directors, and using Rural Health Transformation Program funding for eligible rural ambulance purchases.

TN-T2 Treatment in Place & Alternate Destinations

TACIR highlights Tennessee’s TN-T2 program, which allows reimbursement for treatment in place or transport to approved alternate destinations for eligible TennCare patients. In 2025, approximately 51% of licensed Tennessee ambulance services made at least one TN-T2 reimbursement claim.