HB 83 – SB 160
FISCAL NOTE
Fiscal Review Committee
Tennessee General Assembly
March 14, 2025
Fiscal Analyst: Justin Billingsley | Email: justin.billingsley@capitol.tn.gov | Phone: 615-741-2564
HB 83 – SB 160
SUMMARY OF BILL: Requires a municipality to reimburse a county for any ambulance
services rendered by the county if such the municipality does not provide ambulance services within
its boundaries. Such reimbursement must be provided in a proportion equal to the municipality’s
population to the population of the county, according to the most recent federal census; provided,
no reimbursement may exceed 50 percent of the total cost of providing the ambulance services.
FISCAL IMPACT:
LOCAL GOVERNMENT
REVENUE Counties/Mandatory
FY25-26 & Subsequent Years >$41,215,900
EXPENDITURES Municipalities/Mandatory
FY25-26 & Subsequent Years >$41,215,900
Article II, Section 24 of the Tennessee Constitution provides that: no law of general application shall impose increased expenditure
requirements on cities or counties unless the General Assembly shall provide that the state share in the cost.
Assumptions:
• Pursuant to Tenn. Code Ann. § 7-61-102(b), every county is required to provide at least one
licensed ambulance service through a county service or through the following options: (1) a
license or franchise provided to a private company; (2) a contract with a public, private, or
nonprofit entity; (3) an interlocal agreement with one or more local governments; or (4) an
agreement with a hospital or other healthcare facility.
• Pursuant to Tenn. Code Ann. § 7-61-102(d), a county must be granted approval from a
municipal governing body prior to providing ambulance services in a municipality that has
made provisions for ambulance services.
• Pursuant to Tenn. Code Ann. § 7-61-102(c), municipal governing bodies are authorized to
make provisions for ambulance service within the boundaries of a municipality, and may
provide such services outside its boundaries upon approval of the respective county
governing body, in the case of unincorporated areas, or the municipal governing body, if
the area to be served lies within the boundaries of another municipality.
• Pursuant to Tenn. Code Ann. § 7-61-102(f), counties are authorized to provide ambulance
service to cities or another county as a long as the governing body of that city or county has
formalized the arrangement.
• Based on information provided by the Municipal Technical Advisory Service (MTAS), this
legislation could result in a significant increase in expenditures to a majority of
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municipalities statewide, as MTAS is only aware of 20 of over 345 municipalities in the state
that provide their own ambulance services, not relying on the respective counties for such
service.
• Based on information provided by the County Technical Advisory Service (CTAS), this
legislation would result in a significant increase in revenue to county governments.
• According to CTAS, one example can be provided in Lake County, which incurred
$928,285 in ambulance expenditures in FY23-24.
• Lake County currently provides ambulance services to the cities of Ridgely and Tiptonville.
• According to the U.S. Census Bureau, as of June 1, 2024, Lake County had an estimated
total population of 6,422, while Ridgely has a population of approximately 1,700 and
Tiptonville has a population of approximately 4,000.
• Ridgely accounts for approximately 26.5 percent (1,700 / 6,422) of the county population
and Tiptonville, approximately 62.3 percent (4,000 / 6,422).
• Based on their populations alone, the cities of Ridgely and Tiptonville are assumed to
account for approximately $824,317 of such expenditures [($928,285 x 26.5%) + ($928,285
x 62.3%)]; however, this estimate does not consider many factors, such as number of trips,
length of trips, and the specific services provided, all of which could be factored into the
consideration of how such costs are calculated, which this legislation does not specify.
• Therefore, in this one example, the cities and Ridgely and Tiptonville would be required to
pay Lake County approximately $412,159 in total ($824,317 x 50%).
• The exact number of instances in which similar situations will occur, similar to the example
above, is unknown, but is assumed to be significant.
• Using a conservative approach, this legislation will increase revenue to counties and
expenditures incurred by cities in excess of 100 times the amount estimated in the
preceding example.
• This legislation takes effect July 1, 2025.
• This legislation will result in a mandatory increase in local revenue to counties and local
expenditures incurred by municipalities exceeding $41,215,900 ($412,159 x 100) in FY25-26
and subsequent years.
• It is assumed that any existing agreements between counties and cities which includes the
provision of ambulance services from private entities will not be impacted by this
legislation, with regards to payments made to such entities, as the amount of services
provided by such entities are assumed to be unaffected by this legislation.
CERTIFICATION:
The information contained herein is true and correct to the best of my knowledge.
Bojan Savic, Executive Director