MS 2024-12-N-Hopkins-Jr-October-21-2024-County-Contract-for-Ambulance-Services October 21, 2024

Can a Mississippi county contract with a hospital and a private ambulance provider to subsidize ambulance services without competitive bidding?

Short answer: Yes on all three counts. A Mississippi county may contract with a public hospital and the hospital's private ambulance provider for ambulance services under Section 41-55-3, may subsidize a private ambulance provider under Section 41-55-7 if the county finds the subsidy necessary, and need not advertise for competitive bids when entering such a subsidy contract.

Disclaimer: This is an official Mississippi Attorney General opinion. AG opinions are persuasive authority but not binding precedent. This summary is for informational purposes only and is not legal advice. Consult a licensed Mississippi attorney for advice on your specific situation.

About this page: The plain-English summary, reader guidance, and Q&A below were written by Ezel based on the official AG opinion. The original opinion (linked at the bottom of this page, or PDF in the sidebar) is the authoritative source for any reliance.

View original AG opinion (PDF)

Plain-English summary

Memorial Hospital at Gulfport (MHG) is a public, not-for-profit medical complex jointly owned by the city of Gulfport and Harrison County, with a satellite facility in Stone County. Stone County's board of supervisors found that the county would not have adequate public ambulance services without contracting with MHG and MHG's existing private ambulance provider. Three questions: Can the county sign such an agreement? Can it pay money to MHG and the private ambulance provider? Does it need competitive bids?

The AG said yes on all three. Section 41-55-1 lets political subdivisions contract and cooperate with each other to carry out the purposes of Sections 41-55-1 through 41-55-11, which include ensuring ambulance service in areas where it would otherwise be unavailable. MHG, jointly owned by a city and a county, is a political subdivision. Stone County may contract with it. Section 41-55-7 authorizes the county to subsidize an existing private ambulance service "if they deem necessary to keep such service in operation," based on the board's factual finding. And no competitive bidding is required: neither Section 41-55-7 nor the general public purchasing statute (Section 31-7-13) requires bids for an ambulance subsidy contract.

The AG also flagged 2024's HB 1644 and HB 1489. HB 1644 requires that any contract making a private ambulance provider the exclusive provider in a county or municipality include a provision requiring the contracting provider to have a mutual aid agreement with other ambulance providers for 911 and natural disaster calls when the contracting provider has staffing or equipment shortages. HB 1489 sets minimum reimbursement rates for out-of-network ambulance services under accident or sickness insurance policies.

What this means for you

For boards of supervisors and county attorneys

Three procedural steps for a county-hospital-private-ambulance arrangement: (1) Find on the minutes that the contract is necessary to keep adequate ambulance service in the county. (2) Execute the contract under Section 41-55-1's intergovernmental cooperation authority and Section 41-55-7's subsidy authority. (3) If the contract makes the private provider the exclusive ambulance provider in the county, include a mutual-aid agreement clause as HB 1644 requires.

You do not need competitive bidding for a subsidy contract under Section 41-55-7. The bidding requirement does not apply to ambulance subsidy contracts under that statute.

For hospital administrators contracting with counties

The AG opinion expressly recognizes a public not-for-profit hospital jointly owned by a city and a county as a "political subdivision" for purposes of the intergovernmental contracting authority in Section 41-55-1. That places you on the receiving side of the same statutory authority as another county or city.

For private ambulance service providers

Two things to know. The county can pay you a subsidy under Section 41-55-7 without competitive bidding. But if your contract makes you the exclusive provider in the county, the 2024 HB 1644 requires that the contract include a mutual aid agreement clause: you must have a mutual aid agreement with other ambulance providers to respond to 911 and natural disaster calls when you are short-handed.

For emergency medical services planning at the state level

The 2024 amendments are aimed at making sure exclusive-provider arrangements do not become single points of failure during disasters or shortages. Counties relying on a single provider should be aware that exclusivity now comes with a mutual-aid obligation by statute.

Common questions

Can a Mississippi county contract with a public hospital for ambulance services?

Yes. Section 41-55-1 expressly authorizes intergovernmental cooperation among political subdivisions to carry out the purposes of Sections 41-55-1 through 41-55-11, which include ambulance services. A public hospital jointly owned by a city and a county is a political subdivision.

Can a county subsidize a private ambulance provider?

Yes. Section 41-55-7 lets a county subsidize an existing private ambulance service if the board finds the subsidy necessary to keep the service in operation. The finding should be on the minutes.

Does the county have to put the contract out for competitive bids?

No. The AG previously opined in MS AG Op., Norquist (May 24, 2007), that "advertising for bids is not required" under Section 41-55-7 when the governing authority finds the subsidy necessary. Neither Section 41-55-7 nor Section 31-7-13 (the general public purchasing statute) requires bids in this context.

What does HB 1644 require for exclusive ambulance contracts?

Any contract that makes a private provider the exclusive ambulance provider in a county or municipality must include a provision requiring the contracting provider to have a mutual aid agreement with other ambulance service providers to respond to 911 calls and natural disaster calls when the contracting provider is experiencing equipment or personnel shortages causing delays. The same requirement applies to contracts between emergency medical service districts (under Section 41-59-51) and private providers.

What does HB 1489 do?

HB 1489 sets minimum allowable reimbursement rates for out-of-network ambulance services under accident or sickness insurance policies. It is a payor-side requirement, not a county-contracting requirement.

Can a county contract with an out-of-county private ambulance service?

Yes, if the board finds, consistent with the facts, that the service is adequate and the subsidy is necessary to keep it in operation. MS AG Op., Sutton (Nov. 16, 2018), and MS AG Op., Lee (May 15, 1992), confirm this.

Background and statutory framework

Sections 41-55-1 through 41-55-11, county and intergovernmental ambulance authority. Section 41-55-1 authorizes political subdivisions to contract and cooperate with each other for the provision of ambulance services. Section 41-55-3 authorizes counties to contract with other political subdivisions. Section 41-55-7 authorizes a county to subsidize an existing private ambulance service when the board finds the subsidy necessary. The chapter as a whole supports providing ambulance services where they would otherwise be unavailable.

HB 1644 (2024). Effective July 1, 2024, requires that any contract making a private ambulance provider the exclusive provider in a county or municipality include a mutual aid agreement clause. Same requirement applies to emergency medical service districts.

HB 1489 (2024). Sets minimum reimbursement rates for out-of-network ambulance services under accident or sickness insurance policies.

MS AG Op., Norquist (May 24, 2007). Advertising for bids is not required under Section 41-55-7 for an ambulance subsidy contract where the governing authority finds the subsidy necessary.

Citations

Miss. Code Ann. §§ 41-55-1 to 41-55-11
Miss. Code Ann. § 41-55-3
Miss. Code Ann. § 41-55-7
2024 H.B. 1644
2024 H.B. 1489
MS AG Op., Norquist (May 24, 2007)
MS AG Op., Sutton (Nov. 16, 2018)
MS AG Op., Lee (May 15, 1992)

Source

Original opinion text

October 21, 2024
A. Norris Hopkins, Jr., Esq.
Attorney, Stone County Board of Supervisors
Post Office Box 1510
Gulfport, Mississippi 39502-1510
Re:

Contractual Agreement for Ambulance Services in Stone County

Dear Mr. Hopkins:
The Office of the Attorney General has received your request for an official opinion.
Background
Memorial Hospital at Gulfport ("MHG") is a public, not-for-profit medical complex in Gulfport,
Mississippi, which is jointly owned by the city of Gulfport and Harrison County. Memorial
operates a Stone County facility ("MHG Stone County"). The Stone County Board of Supervisors
has made a finding by resolution spread upon the minutes that adequate public ambulance services
will not be available in Stone County absent a contractual agreement between Stone County,
MHG, and the private ambulance service provider currently doing business with MHG.
Questions Presented
1. May Stone County, Mississippi enter into an agreement for ambulance services with
Memorial Hospital at Gulfport and the ambulance service company providing services to
MHG Stone County Hospital?
2. May Stone County, Mississippi financially contribute to Memorial Hospital at Gulfport
and/or the private ambulance provider for ambulance services in Stone County,
Mississippi?
3. May Stone County, Mississippi enter into such an agreement for ambulance services, as
described above, without advertising for competitive bids?

Brief Response
1. Yes. Counties are authorized to contract with other political subdivisions for such purposes
under Mississippi Code Annotated Section 41-55-3.
2. Yes. Counties are authorized to subsidize an existing privately run ambulance service under
Section 41-55-7.
3. Yes. Our office has previously opined that "advertising for bids is not required" under
Section 41-55-7. MS AG Op., Norquist at 1 (May 24, 2007).
Applicable Law and Discussion
As an initial matter, this opinion solely concerns authority under Mississippi law and does not
address any contractual considerations. Further, this opinion only pertains to the authority of Stone
County, since you submitted your request in your capacity as attorney for the Stone County Board
of Supervisors.
First, you ask whether Stone County may enter into a contractual agreement for ambulance
services with MHG and its current ambulance service provider for ambulance services. The
purpose of Sections 41-55-1 through 41-55-11 includes the provision of ambulance services to
areas where it would otherwise be unavailable, as Stone County has determined via board
resolution. Under Section 41-55-1, "any political subdivision . . . may contract and otherwise
cooperate with . . . any county, city, [or] town . . . in carrying out any of the powers herein conferred
or otherwise effectuating the purposes of Sections 41-55-1 through 41-55-11." As a public hospital
jointly owned by the city of Gulfport and Harrison County, MHG is a political subdivision, and
Stone County may enter into a contract with it.
Second, you ask whether Stone County may financially contribute to MHG and/or its current
ambulance service provider. Section 41-55-7 permits governing authorities to subsidize existing
private ambulance services, "if they deem necessary to keep such service in operation," as Stone
County has determined by board resolution spread upon the minutes. Further, "we have previously
opined that a county may contract with a privately run out of county ambulance service if the
Board of Supervisors finds, consistent with the facts, that such ambulance service is adequate, and
the subsidy is necessary to keep such services in operation." MS AG Op., Sutton at 1 (Nov. 16,
2018) (quoting MS AG Op., Lee at 1 (May 15, 1992)).
We also note that under Section 41-55-1, political subdivisions contracting with counties of the
State of Mississippi for ambulance services may "accept gifts, money, and other property of
whatever kind." Miss. Code Ann. § 41-55-1. Thus, in its entirety, Title 41, Chapter 55 authorizes
counties to contract with other political subdivisions, which includes publicly owned hospitals, for
the provision of ambulance services and to contribute financially to such political subdivision or
its private ambulance service provider in order to effectuate the purposes of the chapter.
Third and finally, you ask whether Stone County may enter into the contractual agreement for
ambulance services described above without advertising for competitive bids. Our office has
previously opined that "advertising for bids is not required" when a county enters into a subsidy
contract with a private ambulance service "where the governing authority finds such to be
necessary." MS AG Op., Norquist at 1 (May 24, 2007). This is because advertising for bids is
required neither by Section 41-55-7, the applicable ambulance services statute, nor Section 31-7-13, the general public purchasing statute. Id.
In conclusion, Stone County is authorized under Mississippi law to enter into a contractual
agreement with Memorial Hospital at Gulfport and its private ambulance service provider, to
contribute financially to those parties for the provision of ambulance services, and to do so without
advertising for competitive bids.
We would also note that House Bill No. 1644 and House Bill No. 1489 of the 2024 Mississippi
Legislative Session created new requirements that may apply to the contractual agreement you
describe.
H.B. 1644 § 1 provides in pertinent part:
(1) Any contract between the board of supervisors of a county or the governing authorities of
a municipality and a private provider of ambulance services for the contracting provider to
be the exclusive provider of ambulance services in the county or municipality, as the case
may be, must contain a provision that requires the contracting provider to have a mutual
aid agreement with other ambulance service providers to respond to 911 and natural
disaster calls and provide service in the county or municipality, as the case may be, during
times and circumstances when the contracting provider is experiencing shortages of
equipment or personnel that cause a delay in responding to calls for service. The
requirements of this section shall also apply to contracts between emergency medical
service districts created under Section 41-59-51 and private providers of ambulance
services.
Laws 2024, H.B. No. 1644, §1, eff. July 1, 2024 (undesignated legislative enactment; official
classification pending); see also Laws 2024, H.B. No. 1489, § 2, eff. July 1, 2024 (undesignated
legislative enactment, official classification pending) (stipulating the minimum allowable
reimbursement rate to an out-of-network ambulance service under an accident or sickness
insurance policy).
If this office may be of any further assistance to you, please do not hesitate to contact us.
Sincerely,
LYNN FITCH, ATTORNEY GENERAL
By:

/s/ Caleb A. Pracht
Caleb A. Pracht
Special Assistant Attorney General