[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 848 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                 S. 848

   To recognize and clarify the authority of the States to regulate 
    intrastate helicopter medical services, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 22, 2009

  Mrs. McCaskill (for herself and Ms. Snowe) introduced the following 
 bill; which was read twice and referred to the Committee on Commerce, 
                      Science, and Transportation

_______________________________________________________________________

                                 A BILL


 
   To recognize and clarify the authority of the States to regulate 
    intrastate helicopter medical services, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Helicopter Medical Services Patient 
Safety, Protection, and Coordination Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) The Federal Aviation Administration is responsible for 
        regulating civil aviation in the United States.
            (2) Each State is responsible for the regulation of public 
        health planning and protection, patient safety and protection, 
        emergency medical services, the quality and coordination of 
        medical care, and the practice of medicine within its 
        jurisdiction.
            (3) Helicopter medical services are an essential component 
        of the health care delivery and emergency medical services 
        system in each State and are integral to each State's 
        management of public health planning and protection, patient 
        safety and protection, emergency medical services, the quality 
        and coordination of medical care, and the practice of medicine 
        within the State's jurisdiction.
            (4) Existing or future regulation of helicopter medical 
        services by the several States is in the public interest.
            (5) Helicopter medical services represent a unique and 
        discrete area of air transportation because those services 
        present issues involving the adequacy and availability of 
        medical services to patients.
            (6) Court rulings and statutory interpretations issued by 
        the Secretary of Transportation have imposed limitations on, 
        impeded, or prevented, the ability of States to effectively 
        regulate helicopter medical services in a manner similar to the 
        regulation of other health care services by the States.
            (7) Those rulings and interpretations have concluded that 
        certain State actions related to public health planning and 
        protection, patient safety and protection, emergency medical 
        services, the quality and coordination of medical care, and the 
        practice of medicine, and related aspects of helicopter medical 
        services, are preempted by Federal law, either pursuant to the 
        preemption provisions of the Airline Deregulation Act of 1978 
        (Public Law 95-504; 92 Stat. 1705) or through the application 
        of the ``field occupation'' preemption doctrine.
            (8) The Airline Deregulation Act of 1978 did not 
        contemplate helicopter medical services, and the use of the Act 
        to strike down intrastate health-related regulations overseeing 
        the provision of helicopter medical services that would 
        otherwise be permissible with respect to any other segment of 
        the health care industry is not in the public interest.
            (9) At the same time, it is also important to ensure that 
        the Federal Aviation Administration's plenary and exclusive 
        jurisdiction over matters of aviation safety is not infringed 
        by any State. Accordingly, any State health-related regulation 
        of helicopter medical services must be harmonized and shall not 
        be inconsistent with Federal regulation of aviation safety 
        because the safe operation of the helicopter medical services 
        flight is of paramount importance.
            (10) Accordingly, there is a need for clarification of 
        existing Federal law so that States may regulate helicopter 
        medical services with respect to public health planning and 
        protection, patient safety and protection, emergency medical 
        services, the quality and coordination of medical care, and the 
        practice of medicine without infringing on the Federal 
        government's plenary power to regulate aviation safety.

SEC. 3. CLARIFICATION OF STATE AUTHORITY OVER HELICOPTER MEDICAL 
              SERVICES.

    (a) In General.--Chapter 401 of title 49, United States Code, is 
amended by adding at the end the following:
``Sec. 40130. Clarification of State authority over helicopter medical 
              services
    ``(a) Clarification of State Authority.--Nothing in this subtitle 
shall prohibit a State from--
            ``(1) requiring medical licenses for the provision of 
        helicopter medical services between locations within the State; 
        or
            ``(2) prescribing regulations relating to the provision of 
        such services if such regulations are prescribed pursuant to 
        subsection (c), (d), or (e).
    ``(b) Applicability of Federal Aviation Safety Authority.--No State 
health-related regulation established pursuant to this section shall 
supersede or be inconsistent with any Federal operating requirement 
with respect to aviation safety.
    ``(c) State Authority Over Medical Services.--A State may prescribe 
regulations relating to the provision of helicopter medical services 
with respect to the following:
            ``(1) The medical qualifications and medical training of 
        helicopter medical personnel, except that a State may not 
        impose any requirement with respect to a pilot.
            ``(2) The obligation of providers of helicopter medical 
        services to comply with the health planning, patient safety, 
        and medical service requirements of the State, including--
                    ``(A) coordination of the interrelationship, 
                interaction, and agreements among providers of 
                helicopter medical services, providers of other 
                emergency medical services, providers of other medical 
                transport services, referring entities, and medical 
                institutions that receive patients transported by 
                providers of helicopter medical services with respect 
                to the transport of patients;
                    ``(B) demonstration of adequate capacity to provide 
                helicopter medical services;
                    ``(C) demonstration of the need for new or expanded 
                helicopter medical services;
                    ``(D) determinations with respect to the number and 
                base location of helicopters used in the provision of 
                helicopter medical services within the State or region 
                of the State or the regulation of competition for 
                specific markets within the State;
                    ``(E) affiliation with health care institutions;
                    ``(F) sanitation and infection control protocols;
                    ``(G) medical records requirements;
                    ``(H) quality of medical care requirements, 
                including participation in patient safety and medical 
                quality control efforts, such as peer review processes, 
                utilization review, and error reporting systems; and
                    ``(I) the proffer of gifts of monetary value (other 
                than training or educational programs) to referring 
                entities (or personnel employed by such entities) 
                within the State.
    ``(d) State Authority Over Medical Services Subject to 
Harmonization Requirement.--A State may prescribe regulations relating 
to the provision of helicopter medical services with respect to the 
following, if such regulations are harmonized with, and do not infringe 
upon, any applicable Federal operating requirements:
            ``(1) The establishment of appropriate medical criteria for 
        determining the appropriate medical institution to receive a 
        patient being transported from the scene at which the patient's 
        injury or accident, or other event resulting in the need for 
        medical services for the patient, occurred.
            ``(2) The specification of service requirements with 
        respect to geographic areas within the State or during 
        specified hours and days.
            ``(3) The coordination of flight requests for emergency 
        helicopter medical services.
            ``(4) The compliance with accreditation requirements 
        regarding medical services, except where such requirements 
        infringe upon relevant Federal operating requirements.
            ``(5) The provision of emergency helicopter medical 
        services to all persons for whom such services are medically 
        necessary and appropriate.
    ``(e) State Authority Over Medical Services Subject to Consistency 
Requirement.--
            ``(1) In general.--Subject to paragraph (2), a State may 
        prescribe regulations relating to the provision of helicopter 
        medical services with respect to the following, if such 
        regulations are consistent with, and do not infringe upon, any 
        applicable Federal operating requirements:
                    ``(A) The necessary medical equipment and supplies 
                to be carried on board or affixed to the helicopter.
                    ``(B) The physical attributes of the helicopter--
                            ``(i) necessary for the provision of 
                        quality medical care, including--
                                    ``(I) permanently installed climate 
                                control systems capable of meeting 
                                specified temperature settings;
                                    ``(II) a configuration that allows 
                                adequate access to the patient, medical 
                                equipment, and medical supplies by the 
                                helicopter medical personnel;
                                    ``(III) use of materials in the 
                                helicopter that are appropriate for 
                                proper patient care;
                                    ``(IV) sufficient electrical supply 
                                to support medical equipment without 
                                compromising helicopter power; and
                                    ``(V) the ability of the helicopter 
                                to transport a patient a certain 
                                distance without refueling within the 
                                State; and
                            ``(ii) necessary--
                                    ``(I) for the protection of 
                                helicopter personnel, ground medical 
                                personnel, and emergency response 
                                personnel; and
                                    ``(II) to ensure that the 
                                helicopter has no structural or 
                                functional defects that may adversely 
                                affect such personnel, such as by 
                                requiring tailroter illumination for 
                                loading patients at night or external 
                                search lights.
                    ``(C) Communication capabilities enabling--
                            ``(i) the helicopter medical personnel to 
                        communicate with emergency medical services and 
                        public safety personnel and personnel at 
                        medical institutions that receive patients 
                        transported by providers of helicopter medical 
                        services; and
                            ``(ii) the flightcrew to communicate with 
                        the helicopter medical personnel, to the extent 
                        that the communications do not interfere with 
                        the safe operation of the flight.
            ``(2) Limitations.--
                    ``(A) Providers licensed in multiple states.--If a 
                provider of helicopter medical services is licensed to 
                provide such services in more than one State and the 
                regulations established pursuant to this subsection by 
                the States in which the provider is licensed are 
                inconsistent, the provider shall comply with the most 
                stringent of such regulations.
                    ``(B) Nondelegation requirement.--A State may not 
                delegate authority provided under this subsection to a 
                political subdivision of the State.
    ``(f) Interstate Agreements.--In regulating the provision of 
helicopter medical services pursuant to this section, a State shall, if 
necessary, establish regulations or negotiate mutual aid agreements 
with adjacent States or providers of helicopter medical services in 
adjacent States to ensure access to helicopter medical services across 
State borders.
    ``(g) Definitions.--In this section:
            ``(1) Helicopter medical services.--The term `helicopter 
        medical services' means the helicopter transport of a patient, 
        in both emergency and nonemergency situations, as well as the 
        medical services provided to such patient in the course of 
        transport by such helicopter.
            ``(2) Federal operating requirements.--The term `Federal 
        operating requirements' means requirements under part A of 
        subtitle VII of title 49, United States Code, and Federal 
        aviation regulations set forth in title 14, Code of Federal 
        Regulations.
            ``(3) Referring entities.--The term `referring entity' 
        means any entity that dispatches or provides a referral for a 
        provider of helicopter medical services, such as a medical 
        institution, an agency providing emergency medical services, or 
        a first responder.''.
    (b) Conforming Amendment.--The table of sections at the beginning 
of chapter 401 of title 49, United States Code, is amended by adding at 
the end the following:

``40130. Clarification of State authority over intrastate helicopter 
                            medical services.''.
                                 <all>