Tennessee Mental Health Transport in 2027: Sheriff Contracts, Secondary Agents, and the State Grant

Every day in Tennessee, someone in a mental health crisis needs a ride from an emergency room or crisis center to a hospital that can admit them. The law hands that ride to the county sheriff. It also lets the sheriff pass the work to a private company, and a state grant helps pay for it. For a van company with trained staff and a secure vehicle, that makes the sheriff a customer.

Crisis and secure rides across the country, and how other states license them, are covered in behavioral health transportation. TennCare rides, including urgent trips home from a crisis stabilization unit, go through the plans’ brokers as the Tennessee guide explains. This page covers only sheriff mental health transports and the grant behind them.

How mental health transport works in Tennessee

Under Tenn. Code Ann. 33-6-901, the county sheriff carries anyone being admitted for emergency or nonemergency involuntary treatment under Title 33, Chapter 6, Parts 4 and 5. The sheriff does not have to make the ride when one of these does instead:

• a secondary transportation agent the sheriff has designated
• a city police department that meets the agent requirements and that the sheriff designates
• a person another part of Title 33 authorizes
• friends, neighbors, relatives, a member of the clergy, or a mental health professional who knows the person

The ride starts with a certificate of need. On the state form MH-5542 (Summer 2024 update), the examiner certifies how the person may travel. Either the person needs no physical restraint or vehicle security and poses no reasonable risk on the way, so an ambulance, a secondary agent, or family and friends may drive. Or the person poses a risk and needs restraint and vehicle security, or the first option is unavailable, so the sheriff or a secondary agent must. Friends and family who transport do so at their own expense, and when the sheriff lets them, they show proof of current auto insurance.

That second option matters for a company. The part of 33-6-901 that lets a sheriff designate agents speaks of people who need no restraint or vehicle security. A later subsection, 33-6-901(d), which the form cites, makes it state policy that people who are a danger to themselves and need restraint or vehicle security ride with the sheriff or a secondary agent the sheriff designates.

What a secondary transportation agent is

A secondary transportation agent is the sheriff’s stand-in for these rides. The sheriff designates one after consulting the county mayor, weighing funding and the characteristics of the people to be carried. Under 33-6-901, the agent must:

• be available 24 hours a day
• provide adequately for the safety and security of the person
• provide appropriate medical conditions for the ride

The agent has the same duties and authority as the sheriff in detaining and transporting the person.

Most agents come in through a contract. Under 33-6-406(c), a sheriff may contract with one or more third parties to make these transports, and the sheriff treats each contractor as the designated secondary transportation agent. Any such contract, and any grant money the sheriff pays under it, is subject to audit by the state comptroller.

How the Mental Health Transport grant works

The same section, 33-6-406(c), creates a grant program for sheriffs, subject to yearly appropriations. The Department of Finance and Administration runs it with the mental health department and TennCare, through its Office of Criminal Justice Programs (OCJP). As of October 2026, OCJP’s grants manual sets these terms:

• Who applies. Sheriff’s offices, which are the only eligible applicants in the 2026 notice. A sheriff that uses a private company applies first, then subcontracts.
• How much. It is an endowment grant with no pre-approved budget. Each office reports its emergency mental health transports from the most recent year with data, and a formula splits the appropriation by eligible transports statewide. The office receives its full award shortly after the contract starts.
• Who rides. People in a mental health crisis who have not committed a crime. Anyone in the sheriff’s custody on a charge who is not free on bond or released on recognizance is ineligible.
• What it pays for. Any reasonable, necessary, and allocable transport cost, including mileage at the state rate, vehicles and equipment, training, staff time, and third-party vendor transport costs.
• What it will not pay for. Rides where a physician, psychologist, or designated professional finds that friends, relatives, clergy, or a familiar mental health professional can drive.
• Reports. Quarterly transport logs listing the date, the dispatch number, and the pickup and drop-off addresses, due October 15, January 15, April 15, and July 31, plus a year-end spending report by July 31.

The grant also sets the tone. Funded agencies must use unmarked vehicles, wear soft uniforms rather than tactical gear, adopt a humane transport policy, and complete mental health awareness training every year. That training should cover trauma-informed care, verbal de-escalation, suicide prevention, medications, symptoms, developmental disabilities, and dementia.

OCJP set the 2026 application window at September 4 to October 9, 2026, in its grants portal. Awards can be large. Hamilton County’s commission accepted $833,844 for its sheriff on October 1, 2025. Sheriffs also choose how to spend it: in April 2026, Anderson County’s budget committee moved $35,000 from the sheriff’s contract line for private mental health transport into a vehicle of its own. Approach your sheriff before its budget is set.

What the grant requires of a contracted company

A sheriff may sign a subcontract or a letter of agreement with a private company. The manual accepts a company that holds a valid Basic Life Support certification from the Tennessee Department of Health under its ambulance service rules. A company without one must meet the agent rules in 33-6-901, and its subcontract must include the terms below. If you run an ambulance service, the manual adds that, under Department of Health guidance as of August 2021, you need a Basic Life Support license in each county where you act as an agent.

Staff

• Service 24 hours a day, 7 days a week, 365 days a year.
• Before anyone works with patients or their health information: a nationwide fingerprint background check and checks of the Tennessee Department of Health Abuse Registry, the national sex offender registry, and the federal OIG exclusion list.
• A five-panel drug test (amphetamines, cocaine, opiates, PCP, and THC) before assignment, a physical by a licensed physician, and a Tennessee licensed psychiatric or psychological provider’s certification that the person has no impairment affecting essential job functions.
• Mental Health First Aid for everyone who works with patients, and CPR and AED, first aid, and emergency oxygen certifications for every driver.
• A valid license of the right class for the vehicle, and an updated motor vehicle record reviewed throughout the driver’s employment.
• A report to a supervisor within 24 hours of any arrest, indictment, conviction, or citation.
• Crisis Intervention Team training is highly recommended, and Handle with Care training is recommended.

See NEMT driver background checks and drug testing for NEMT drivers for setting up the files.

Vehicles

• Driver-controlled door locks, so the rider cannot open a door without staff.
• A secure, clear safety panel between the driver and the rider, and a mesh or grille bulkhead between the rider and any cargo area in a van.
• Tinted windows, a portable AED, a first aid kit, a lockable container for the rider’s belongings, and a rider area free of ligature risks.
• A booster seat when a rider under 18 needs one, and a hands-free phone or radio that reaches emergency help anywhere in the state.

On the ride

• Search each rider before the trip, with a witness or a recording, preferably both, and match the driver’s gender to the rider’s whenever possible.
• Ask the referring facility about recent medications or treatments that could affect the ride.
• Carry no more than two riders in a five-seat vehicle or four in a 10-passenger van, with at least two staff for any group.
• On trips over 120 miles or two hours, send two staff for each rider and stop for a restroom break at least every two hours.

Notice, waiting time, and who pays the rest

Before the ride, the sheriff or agent tells the receiving hospital where the person is and the expected arrival time, and names the people who will drive. The agent hands over the original certificate of need. For a state-run hospital, the examiner also gives a written statement that the hospital has room, and the sheriff or agent does not have to take custody without both papers. Deliver both to the state hospital. If the sheriff or agent does not, the transporting county is charged all the costs of the person’s admission and treatment. If the agent arrives within the expected time, it waits for the admission evaluation, but no longer than one hour and 45 minutes. After that, the hospital is responsible. In Shelby County, the duty ends once the person is delivered.

If the person is not admitted while the agent is still required to wait, the agent takes the person back to the county the trip started from. Once that duty has ended, the hospital arranges the return.

The county that first transports the person owns the rest of that person’s transport, even when the evaluation happens in a second county and the admission in a third. When another county’s sheriff or agent makes a leg of the trip, it may bill the first county. Keep your trip records clean enough to send that bill.

What a county contract looks like

Roane County shows the shape of a recent deal. On May 11, 2026, its commission voted 15 to 0 for Resolution 05-26-11, after its previous contractor abruptly went out of business. The sheriff designated a licensed ambulance company as the county’s secondary transportation agent under a temporary agreement that ran from April 14 to June 30, 2026 and can renew each fiscal year if the commission funds it. Its main terms:

• Medical facilities call the sheriff’s office, and the sheriff’s office calls the company’s dispatch.
• The company bills private insurance for insured riders and bills the sheriff only for uninsured involuntary riders, while the sheriff holds the grant.
• The company indemnifies the county and the sheriff, and either side may end the agreement on 30 days’ written notice.

The attached fee schedule uses 2026 Medicare allowable ambulance rates:

Service	Fee
Basic life support, non-emergency	$271.76
Basic life support, emergency	$434.82
Advanced life support, non-emergency	$326.11
Advanced life support, emergency	$516.35
Specialty care transport	$883.23
Each mile with the patient on board	$9.33

Those are ambulance rates for an ambulance service. A van company without a medical crew would propose its own per-trip and per-mile rates. See NEMT vs ambulance for where that line falls.

How to become a sheriff’s mental health transport provider

1. Call the sheriff’s office. Ask who handles mental health transports, how many the office makes in a year, how far they go, and whether it already has a contractor.
2. Ask about the grant. Find out whether the office applied by the October 9, 2026 deadline and what it plans to spend the award on.
3. Build to the manual first. Fit at least one vehicle with the partition, locks, bulkhead, AED, and property box the manual lists, and finish every staff check before you pitch.
4. Write a humane transport policy. Cover searches, gender matching, restraint, long trips, and returns, and attach your training certificates.
5. Confirm your insurance. Expect an indemnity clause, so ask your agent to confirm in writing that your auto and general liability policies cover these rides. See NEMT insurance requirements.
6. Propose a letter of agreement. Offer rates, a response time, and 24-hour dispatch, and remember the sheriff must consult the county mayor before designating you. Ask the hospitals in the county to call the sheriff when they need a ride, as Roane County’s agreement provides.
7. Check local vehicle rules. In Nashville, Metro licenses vehicles for hire, so read the Nashville page before you run vans there.

County contracts like these sit alongside other public ride work. See government NEMT contracts for how counties buy and pay.