[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[S. 2376 Introduced in Senate (IS)]
112th CONGRESS
2d Session
S. 2376
To recognize and clarify the authority of the States to regulate air
ambulance medical standards pursuant to their authority over the
regulation of health care services within their borders, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
April 26, 2012
Ms. Snowe (for herself and Ms. Cantwell) 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 air
ambulance medical standards pursuant to their authority over the
regulation of health care services within their borders, 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 ``Air Ambulance Services Clarification
Act''.
SEC. 2. CLARIFICATION OF STATE AUTHORITY OVER THE MEDICAL STANDARDS OF
AIR AMBULANCE SERVICES.
(a) In General.--Chapter 401 of title 49, United States Code, is
amended by adding at the end the following:
``SEC. 40131. CLARIFICATION OF STATE AUTHORITY OVER AIR AMBULANCE
MEDICAL STANDARDS AND MEDICAL CARE RELATED LICENSING
REQUIREMENTS.
``(a) Rule of Construction.--With respect to an air ambulance and
the medical services provided within an air ambulance, the term `law,
regulation, or other provision having the force and effect of law
related to a price, route, or service of an air carrier', as used in
section 41713, may not be construed to include any medical care related
license and certification requirements based on medical standards
effectuated pursuant to a State's authority over the licensure and
regulation of health care within its borders.
``(b) Definitions.--In this section:
``(1) Air ambulance.--The term `air ambulance' means a
fixed wing aircraft or a helicopter used for the provision of
care and patient transport.
``(2) Air ambulance medical personnel.--The term `air
ambulance medical personnel' means the doctors, nurses,
paramedics, emergency medical technicians, physician
assistants, respiratory therapists, or other medical
specialists providing air ambulance services aboard an air
ambulance.
``(3) Air ambulance operator.--The term `air ambulance
operator' means a commercial holder of a part 121 or part 135
certificate that has received, from the Federal Aviation
Administration--
``(A) an operations specification A021 (Air
Ambulance Operations--Helicopter); or
``(B) an operations specification A024 (Air
Ambulance Operations--Airplane).
``(4) Air ambulance provider.--The term `air ambulance
provider' means a program or agency licensed by the State to
provide air ambulance medical services.
``(5) Air ambulance services.--The term `air ambulance
services' means the medical care and patient transport provided
aboard an air ambulance.
``(6) Federal operating requirements.--The term `Federal
operating requirements' means--
``(A) the requirements under part A of subtitle VII
of title 49, United States Code;
``(B) Federal aviation regulations set forth in
title 14, Code of Federal Regulations; and
``(C) the operation specifications and notices to
airmen issued by the Federal Aviation Administration.
``(7) Medical care related license or certification.--The
term `medical care related license or certification' means the
permission granted by a State to air ambulance medical
personnel, air ambulance providers, or a specific air ambulance
for providing medical care and transport that--
``(A) is based solely on, and restricted to, the
State's authority to set standards for providing health
care within its borders; and
``(B) is not construed to reference any Federal
Operating Requirements.
``(8) Medically-related dispatch.--The term `medically-
related dispatch'--
``(A) means a medically-related request for an air
ambulance to provide medical care and transport to a
patient; and
``(B) does not refer to the flight dispatch or
operational control of an aircraft.
``(9) Referring entities.--The term `referring entity'
means any entity that makes a request for medically-related
dispatch of an air ambulance or provides a referral for a
provider of air ambulance services, such as a medical
institution, an agency providing emergency medical services, or
a first responder.
``(10) Routine.--The term `routine' means medical care and
transport that is provided more than 25 times per year in the
applicable State.
``(11) Scene.--The term `scene' means the location at which
the patient's injury or illness, or other event resulting in
the need for emergency medical care and transport for the
patient occurred.
``(c) Medical and Related Medical Care Standards To Ensure the
Consistent Quality of Air Ambulance Services.--This section shall apply
to medical and related medical care standards that--
``(1) are required by a State as a condition of providing--
``(A) a license or certification to an air
ambulance, air ambulance providers, and air ambulance
medical personnel based in such State; or
``(B) routine medical care and transport to
patients in such State; and
``(2) address--
``(A) the quality of emergency medical care
provided to patients;
``(B) the qualifications and training of air
ambulance medical personnel, scope of practice,
credentialing, and ongoing clinical experience in
critical care settings;
``(C) the medical direction and clinical oversight
of patient care including qualifications and
credentialing of physicians providing medical direction
or clinical oversight;
``(D) the maintenance of medical records and data
collection and reporting;
``(E) health outcome and proficiency measures;
``(F) participation in patient safety and quality
control initiatives, such as peer review, utilization
review, and error reporting;
``(G) medically-related accreditation;
``(H) medical equipment, devices, and supplies on
board the air ambulance including the design, capacity,
and performance of such equipment;
``(I) sanitation, infection control,
decontamination of the air ambulance bay, infectious
hazards, and medical universal precautions;
``(J) the design and configuration of the air
ambulance medical compartment for the provision of
quality medical care that allows adequate access to the
patient for the purposes of resuscitation and emergency
procedures consistent with the medical mission, medical
equipment, and medical supplies by the medical
personnel during flight without becoming unsecured;
``(K) medically-related air ambulance features and
capability specifications necessary and appropriate for
the provision of quality medical care related to--
``(i) permanently installed medically-
related climate control system requirements
capable of meeting specified temperature
settings;
``(ii) the use of materials in the air
ambulance that are appropriate for a proper
patient care environment;
``(iii) providing medically appropriate
care and transport to patients, including
special populations, such as neonatal or
pediatric patients;
``(iv) ensuring sufficient electrical
supply to adequately power required medical
equipment without reliance on medical equipment
batteries and without compromising the
ambulance power to lift or fly;
``(L) patient safety standards related to--
``(i) loading or unloading patients; and
``(ii) refueling with a patient on board;
``(M) communication capabilities--
``(i) between air ambulance medical
personnel and public safety, emergency medical
service agencies and hospitals; and
``(ii) that allow for functional internal
communication within the air ambulance for
medical purposes; and
``(N) coordination and oversight over a State`s
emergency medical system and the air ambulance
provider's participation in such system, such as
standards that--
``(i) designate levels of medical
capability, medical appropriateness, and
medical staffing of air ambulances, such as
medical staffing configurations for particular
medical missions or the different medical-
related licenses or certifications required for
air ambulances and air ambulance medical
personnel that provide advanced life support,
critical care, or specialty care;
``(ii) establish medically-related dispatch
and destination protocols for patients with
emergency medical conditions being transported
that coordinate requests for air ambulance
service response based on the medical
appropriateness of the air ambulance to meet
the patient's need for medical care and
transport to the appropriate medical
institution consistent with patient condition,
such as protocols for determining the
appropriate--
``(I) mode of transport (ground
versus air) in accordance with
available evidence-based triage
criteria;
``(II) available air ambulance to
transport a patient in accordance with
its capability to meet the patient's
medical need; and
``(III) medical institution to
receive the patient, such as trauma,
burn, chest pain, or stroke center;
``(iii) require the air ambulance provider
to identify its primary service area and its
service availability and any updates or changes
to such area or availability for the purpose of
coordination of ambulance response;
``(iv) require an air ambulance operator
agency to identify the medical institutions the
air ambulance can reach from its base location
within a specified period of time without
refueling;
``(v) require the air ambulance operators
to provide, for the purpose of coordination of
patient care and medical decision making,
reasonably accurate estimated times of arrival
with due consideration of safety measures,
current location, and status of available air
ambulances to referring entities; and
``(vi) prohibit practices which may impede
the proper functioning of such system, such
as--
``(I) referring entities serially
contacting air ambulance providers
until an air ambulance provider agrees
to medically-related dispatch (also
known as helicopter shopping);
``(II) indicating false or
inaccurate ambulance availability or
estimated times of arrival to a
referring entity;
``(III) exclusive agreements
between hospitals and air ambulance
providers or between air ambulance
providers and referring entities;
``(IV) proffers of gifts by air
ambulance providers to referring
entities other than solely for medical
education purposes; or
``(V) representations by air
ambulance providers to referring
entities that the air ambulance and the
air ambulance medical personnel can
provide a level of care beyond its
scope of medical capability.
``(d) Limitations.--A medical or related medical care standard is
not within the scope set forth in subsection (c) if such standard has
the effect of--
``(1) superseding, or being inconsistent with, any Federal
operating requirement with respect to aviation safety;
``(2) denying licensure to an air ambulance, air ambulance
medical personnel, or air ambulance provider that otherwise
meets such standard from providing routine care and transport
to a patient between 2 locations within a State based solely on
the ambulance's base geographic location being within another
State;
``(3) preventing an air ambulance licensed in 1 State from
transporting a patient into or out of another state on a non-
routine basis; or
``(4) impeding intrastate transport of a patient as a
result of the delegation by the State to a political
subdivision within the State of the development or oversight of
the standard.
``(e) Limitation of Scope.--The absence of any medical standard
from subsection (c) does not create an inference that such standard is
or is not a `law, regulation or other provision having the force and
effect of law related to a price, route or service of an air
carrier'.''.
(b) Conforming Amendment.--The table of contents for such chapter
401 is amended by adding at the end the following:
``40131. Clarification of State authority over air ambulance medical
standards and medical care related
licensing requirements.''.
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