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.

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.''.

Summary: Air Ambulance Services Clarification Act - Requires that 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, for federal preemption purposes, 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. Describes the medical and related medical care standards to which this Act applies.