ND HB1365

Requires licensed ambulance services (basic or advanced life support) serving territories outside cities with populations greater than 6,500 (2020 census) to form rural ambulance service districts by June 30, 2025, unless exempted as county-owned, city-owned, tribal/federal-owned, or part of joint powers agreements.

Allows rural ambulance service districts to levy property taxes up to 15 mills annually, with an additional 10 percent depreciation expense for equipment and ambulance replacement in a dedicated sinking fund.

Permits districts to dissolve without voter approval if they do not provide emergency medical services, and allows territories to withdraw from districts if they have written agreements with adjacent emergency medical services operations.

Requires withdrawn, exempted, or dissolved territories to remain liable for their proportionate share of outstanding district obligations through continued mill levies until debts are paid.

Directs state financial assistance for emergency medical services (after June 30, 2025) to be distributed to the political subdivision owning the licensed ambulance service or responsible for the emergency medical service program.