A. A special health care district may maintain and operate an ambulance service or pay the costs of an ambulance service contract if a majority of the qualified electors voting in a regular or special election approve the imposition of the tax necessary to defray the costs of the service.

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B. The continued imposition of the tax necessary to defray the costs of the service shall be approved by a majority of the qualified electors voting in a regular or special election at least every five years after the date of the initial imposition.

C. Except for the initial year of imposition and any subsequent year in which the electors vote to approve or disapprove the imposition of the tax to defray the costs of the ambulance service, the cost to be incurred for ambulance services shall be included in the amount of the estimate of the district’s needs submitted to the board of supervisors under section 48-5563. Otherwise, it shall be stated separately and included in the levy only if approved by a majority of the qualified electors.