SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Air Ambulance Patient Safety, 
Protection, and Coordination Act''.

SEC. 2. CLARIFICATION OF STATE AUTHORITY OVER THE MEDICAL ASPECTS 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. 40130. Clarification of State authority over the medical aspects 
              of air ambulance services
    ``(a) Clarification of State Authority.--Pursuant to a State's 
authority over the licensure and regulation of health care services 
within its borders, a State may prescribe licensing and other 
regulatory requirements related to the medical aspects of intrastate 
air ambulance services in the same manner that it regulates other 
health care services within its borders and may integrate such services 
into the State's emergency medical services system, including by 
establishing requirements related to the following:
            ``(1) The quality of emergency medical care provided to 
        patients by air ambulances, including--
                    ``(A) the medical qualifications and medical 
                training of medical personnel;
                    ``(B) medical records and data collection and 
                reporting;
                    ``(C) outcome and proficiency measures;
                    ``(D) affiliation with health care institutions for 
                medical oversight, critical care medical education, and 
                clinical experience in critical care settings;
                    ``(E) participation in patient safety and quality 
                control initiatives, such as peer review, utilization 
                review, and error reporting;
                    ``(F) medical accreditation;
                    ``(G) licensing of personnel including scope of 
                practice and credentialing; and
                    ``(H) medical oversight.
            ``(2) The availability of air ambulance services provided 
        to patients with emergency medical conditions, including--
                    ``(A) service during specified hours and days to 
                ensure the availability of life-saving medical services 
                as part of the State's emergency medical services 
                system; and
                    ``(B) coordination of services, agreements, and 
                flight requests for patients with emergency medical 
                conditions 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.
            ``(3) Communication between--
                    ``(A) emergency medical and public safety agencies 
                and hospitals; and
                    ``(B) the flightcrew and air ambulance medical 
                personnel to the extent that the communications do not 
                interfere with the safe operation of the flight.
            ``(4) The accessibility of emergency medical care provided 
        by air ambulances and the incorporation and integration of air 
        ambulance services into State emergency medical services 
        systems, including--
                    ``(A) access to air ambulance services in regions 
                of a State;
                    ``(B) the provision of services to all persons for 
                whom such services are medically necessary and 
                appropriate regardless of ability to pay;
                    ``(C) the proffer of gifts of monetary value to 
                referring entities;
                    ``(D) medical criteria, based on the patient's 
                medical need for transport 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, for determining the appropriate--
                            ``(i) mode of transport (ground versus air) 
                        utilizing evidence-based triage criteria to the 
                        extent available;
                            ``(ii) air ambulance to be utilized to 
                        transport a patient in accordance with its 
                        capability to meet the patient's medical need; 
                        and
                            ``(iii) medical institution to receive the 
                        patient.
            ``(5) The acceptability of air ambulance services to ensure 
        the adequate and appropriate provision of medically necessary 
        emergency medical care provided by air ambulances to protect 
        critically ill and injured patients, including--
                    ``(A) medical equipment, devices, and supplies to 
                be carried on board or affixed to the air ambulance;
                    ``(B) sanitation and infection control;
                    ``(C) licensing of the air ambulance agency or 
                program;
                    ``(D) licensing of the ambulance vehicle;
                    ``(E) truth in advertising requirements;
                    ``(F) physical attributes of the air ambulance 
                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 medical personnel;
                            ``(iii) the use of materials in the air 
                        ambulance that are appropriate for proper 
                        patient care;
                            ``(iv) sufficient electrical supply to 
                        support medical equipment without compromising 
                        the ambulance power; and
                            ``(v) the ability of the air ambulance to 
                        transport a patient a certain distance without 
                        refueling within the State.
            ``(6) Physical attributes of the air ambulance necessary--
                    ``(A) for the protection of the ambulance, ground, 
                and emergency response personnel; and
                    ``(B) to ensure that the air ambulance has no 
                structural or functional defects that may adversely 
                affect such personnel, such as by requiring the 
                provision of tailrotor illumination for loading 
                patients at night or external search lights.
    ``(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) Limitations.--
            ``(1) In general.--State requirements and regulations 
        prescribed pursuant to this section must be in accordance with 
        objective, competitive, and transparent processes designed to 
        ensure the highest quality of emergency medical care and 
        patient safety, best outcomes, and access to life-saving 
        emergency medical services as part of an integrated emergency 
        medical services system.
            ``(2) Prices.--This section shall not be construed to allow 
        State regulation of the prices charged by air ambulances for 
        their services.
            ``(3) Providers licensed in multiple states.--If an air 
        ambulance is licensed to provide services in more than one 
        State and the regulations established pursuant to this 
        subsection by the States are inconsistent, the provider shall 
        comply with the most stringent of such regulations.
            ``(4) Nondelegation requirement.--A State may not delegate 
        authority provided under this section to a political 
        subdivision of the State.
    ``(d) Interstate Agreements.--In regulating the provision of air 
ambulance services pursuant to this section, a State shall, if 
necessary, establish regulations or negotiate mutual aid agreements 
with adjacent States or air ambulances to ensure access to air 
ambulance services across State borders.
    ``(e) Definitions.--
            ``(1) Air ambulance services.--The term `air ambulance 
        services' means the transport by an air ambulance 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 air ambulance.
            ``(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 air ambulance services, such as a medical 
        institution, an agency providing emergency medical services, or 
        a first responder.''.
    (b) Conforming Amendment.--The analysis for such chapter is amended 
by adding at the end the following:

``40130. Clarification of State authority over the medical aspects of 
                            air ambulance services.''.
Air Ambulance Patient Safety, Protection, and Coordination Act - Authorizes states to regulate medical aspects of intrastate air ambulance services with respect to: (1) the quality of emergency medical care provided to patients by air ambulances; (2) the availability of air ambulance services provided to patients with emergency medical conditions; (3) communication between emergency medical and public safety agencies and hospitals as well as the flightcrew and air ambulance medical personnel; (4) the accessibility of emergency medical care provided by air ambulances and the incorporation and integration of air ambulance services into state emergency medical services systems; (5) the acceptability of air ambulance services to ensure the adequate provision by air ambulances of medically necessary emergency medical care to critically ill and injured patients; and (6) the physical attributes of the air ambulance necessary for protection of the ambulance, ground, and emergency response personnel.

Requires an air ambulance medical service provider licensed in more than one state, if the different state air ambulance medical services regulations are inconsistent, to comply with the most stringent regulation.

Requires a state, if necessary, to establish regulations or negotiate mutual aid agreements with adjacent states or air ambulances to ensure access to air ambulance services across state borders.
To recognize and clarify the authority of the States to regulate the medical aspects of intrastate air ambulance services pursuant to their authority over health care services, patient safety and protection, emergency medical care, the quality and coordination of medical care, and the practice of medicine within their jurisdictions.