II 

112TH CONGRESS 

1ST SESSION S. 1407 

To amend title XVIII of the Social Security Act to establish accreditation 

requirements for suppliers and providers of air ambulance services, and 

for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JULY 22, 2011 

Ms. SNOWE (for herself and Ms. CANTWELL) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to establish 

accreditation requirements for suppliers and providers 

of air ambulance services, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Air Ambulance Medi5 care Accreditation and Accountability Act’’. 

6 SEC. 2. ACCREDITATION REQUIREMENT. 

7 (a) IN GENERAL.—Section 1834 of the Social Secu8 rity Act (42 U.S.C. 1395m) is amended by adding at the 

9 end the following new subsection: 


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1 ‘‘(p) ACCREDITATION REQUIREMENT FOR AIR AMBU2 LANCE SERVICES.— 

3 ‘‘(1) IN GENERAL.—Beginning with the date 

4 that is 2 years after the date of enactment of the 

5 Air Ambulance Medicare Accreditation and Account6 ability Act, with respect to air ambulance services 

7 for which payment is made under the fee schedule 

8 established under subsection (l) and that are fur9 nished by a supplier or provider (directly or under 

10 an arrangement described in subsection (l)(1)), pay11 ment may only be made for such services provided 

12 by an air ambulance if— 

13 ‘‘(A) the supplier or provider provides for 

14 appropriate medical oversight by a physician 

15 (as determined by the Secretary); and 

16 ‘‘(B) except as provided in paragraph (5), 

17 the air ambulance is accredited by an accredita18 tion organization designated by the Secretary 

19 under paragraph (3)(B) as a level III or higher 

20 air ambulance. 

21 ‘‘(2) ACCREDITATION LEVELS.—The Secretary 

22 shall establish a process for accrediting the air am23 bulances of suppliers and providers of air ambulance 

24 services. Under such process, an accreditation orga25 nization designated by the Secretary under paraVerDate Mar 15 2010 00:44 Jul 23, 2011 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1407.IS S1407

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1 graph (3)(B) may accredit an air ambulance of a 

2 supplier or provider of air ambulance services at any 

3 of the following levels (listed from lowest to highest 

4 level of accreditation): 

5 ‘‘(A) LEVEL III.—The air ambulance— 

6 ‘‘(i) has the capability and scope of 

7 practice to provide advanced resuscitation 

8 during transport, including the criteria de9 scribed in paragraph (4)(B); and 

10 ‘‘(ii) meets such other criteria as the 

11 Secretary determines appropriate for such 

12 accreditation. 

13 ‘‘(B) LEVEL II.—The air ambulance— 

14 ‘‘(i) meets the criteria for being ac15 credited as a level III air ambulance (as 

16 described in subparagraph (A)); 

17 ‘‘(ii) has the capability to provide care 

18 during transport at the level of care and 

19 scope of practice of a hospital emergency 

20 department, including the criteria de21 scribed in paragraph (4)(C); and 

22 ‘‘(iii) meets such other criteria as the 

23 Secretary determines appropriate for such 

24 accreditation. 

25 ‘‘(C) LEVEL I.—The air ambulance— 


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1 ‘‘(i) meets the criteria for being ac2 credited as a level II air ambulance (as de3 scribed in subparagraph (B)); 

4 ‘‘(ii) has the capability to provide care 

5 during transport at the level of care and 

6 scope of practice of a tertiary level inten7 sive care unit, including the criteria de8 scribed in paragraph (4)(D); and 

9 ‘‘(iii) meets such other criteria as the 

10 Secretary determines appropriate for such 

11 accreditation. 

12 ‘‘(3) ACCREDITATION ORGANIZATIONS.— 

13 ‘‘(A) FACTORS FOR DESIGNATION OF AC14 CREDITATION ORGANIZATIONS.—The Secretary 

15 shall consider the following factors in desig16 nating accreditation organizations under sub17 paragraph (B) and in reviewing and updating 

18 the list of accreditation organizations des19 ignated pursuant to subparagraph (C): 

20 ‘‘(i) The ability of the organization to 

21 provide timely reviews of applications for 

22 such accreditation. 

23 ‘‘(ii) Whether the organization uses 

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1 gies to ensure adherence to the accredita2 tion criteria described in paragraph (2). 

3 ‘‘(iii) The ability of the organization 

4 to take into account the capacities of and 

5 special circumstances applicable to air am6 bulances of suppliers or providers of air 

7 ambulance services located in a rural area 

8 (as defined in section 1886(d)(2)(D)). 

9 ‘‘(iv) The ability of the organization 

10 to take into account the capacities of and 

11 special circumstances applicable to air am12 bulances owned and operated by units of 

13 State or local government. 

14 ‘‘(v) Whether the organization has es15 tablished reasonable fees for such accredi16 tation. 

17 ‘‘(vi) Whether the organization has 

18 applicable accreditation experience. 

19 ‘‘(vii) Whether the organization has 

20 developed an accreditation program that is 

21 adequate and appropriate to the goal of 

22 ensuring high-caliber air ambulance serv23 ices. 


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1 ‘‘(viii) The ability of the organization 

2 to effectively enforce the accreditation cri3 teria described in paragraph (2). 

4 ‘‘(ix) Such additional factors specified 

5 by the Secretary regarding quality, medical 

6 services, and emergency medical services 

7 integration. 

8 ‘‘(x) Such other factors as the Sec9 retary determines appropriate. 

10 ‘‘(B) DESIGNATION.—The Secretary shall 

11 designate organizations to accredit air ambu12 lances of suppliers and providers of air ambu13 lance services under this subsection. The list of 

14 accreditation organizations so designated may 

15 be modified pursuant to subparagraph (C). 

16 ‘‘(C) REVIEW AND MODIFICATION OF LIST

17 OF ACCREDITATION ORGANIZATIONS.— 

18 ‘‘(i) IN GENERAL.—The Secretary 

19 shall review the list of accreditation organi20 zations designated under subparagraph (B) 

21 taking into account the factors under sub22 paragraph (A). Taking into account the re23 sults of such review, the Secretary may, by 

24 regulation, modify the list of accreditation 


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1 organizations designated under subpara2 graph (B). 

3 ‘‘(ii) SPECIAL RULE FOR ACCREDITA4 TIONS DONE PRIOR TO REMOVAL FROM

5 LIST OF DESIGNATED ACCREDITATION OR6 GANIZATIONS.—In the case where the Sec7 retary removes an organization from the 

8 list of accreditation organizations des9 ignated under subparagraph (B), any air 

10 ambulance of a supplier or provider that is 

11 accredited by the organization during the 

12 period beginning on the date on which the 

13 organization is designated as an accredita14 tion organization under subparagraph (B) 

15 and ending on the date on which the orga16 nization is removed from such list shall be 

17 considered to have been accredited by an 

18 organization designated by the Secretary 

19 under subparagraph (B) for the remaining 

20 period such accreditation is in effect. 

21 ‘‘(4) CRITERIA FOR ACCREDITATION.— 

22 ‘‘(A) IN GENERAL.—Not later than 1 year 

23 after the date of enactment of the Air Ambu24 lance Medicare Accreditation and Accountability 

25 Act, the Secretary shall establish criteria for 


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1 use by an accreditation organization designated 

2 under paragraph (3)(B) to evaluate an air am3 bulance of a supplier or provider of air ambu4 lance services for the purpose of accreditation 

5 of such air ambulance. Such criteria shall be 

6 specific to each accreditation level described in 

7 paragraph (2) and include, at a minimum, the 

8 criteria applicable to such level under such 

9 paragraph. 

10 ‘‘(B) LEVEL III CRITERIA DESCRIBED.—In 

11 the case of accreditation of an air ambulance of 

12 a supplier or provider as a level III air ambu13 lance, the criteria described in subparagraph 

14 (A) shall include the following: 

15 ‘‘(i) PROVISION OF PATIENT CARE.— 

16 Minimum accreditation criteria related to 

17 the provision of patient care, including— 

18 ‘‘(I) standards that require the 

19 air ambulance to have available dur20 ing transport, medical equipment for 

21 the proper provision of patient care 

22 consistent with the provision of ad23 vanced resuscitation and life support, 

24 including communications necessary 

25 for the coordination of patient care, 


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1 patient monitoring systems, on-board 

2 suction, oxygen, and electrical systems 

3 to maintain medical devices; 

4 ‘‘(II) standards for maintaining a 

5 medically suitable patient care envi6 ronment (including sanitation and in7 fection control and permanently in8 stalled climate control); 

9 ‘‘(III) standards for the design of 

10 aircraft medical bays to ensure access 

11 to medical equipment and patients in 

12 a manner that enables the medical 

13 crew to perform basic and advanced 

14 resuscitation and life support medical 

15 interventions while secure; 

16 ‘‘(IV) standards for the medical 

17 training and qualifications of the med18 ical crew of the air ambulance; 

19 ‘‘(V) standards for medical over20 sight; 

21 ‘‘(VI) standards for the makeup 

22 of the medical crew of the air ambu23 lance and for the equipment and air24 craft attributes needed for specific 

25 medical missions; and 


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1 ‘‘(VII) standards and reporting 

2 requirements related to quality assur3 ance, peer review, and outcomes and 

4 proficiency measures. 

5 ‘‘(ii) SERVICE REQUIREMENTS.—In 

6 the case of air ambulance services fur7 nished in a State that does not impose 

8 minimum service requirements related to 

9 appropriate utilization and transport, such 

10 minimum service requirements, including— 

11 ‘‘(I) standards for licensing by 

12 the State; 

13 ‘‘(II) standards for transport 

14 from emergency scene calls of all indi15 viduals regardless of ability to pay; 

16 ‘‘(III) standards for minimum 

17 availability for scene response (weath18 er permitting); 

19 ‘‘(IV) standards for response to 

20 emergency scene calls within a speci21 fied flight time; 

22 ‘‘(V) standards for adherence to 

23 established criteria for the appropriate 

24 medical institution to receive a patient 

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1 cluding such criteria published by ap2 propriate professional medical associa3 tions); and 

4 ‘‘(VI) standards for appropriate 

5 utilization and transport. 

6 ‘‘(C) LEVEL II CRITERIA DESCRIBED.—In 

7 the case of accreditation of an air ambulance of 

8 a supplier or provider as a level II air ambu9 lance, the criteria described in subparagraph 

10 (A) shall include the capability to provide care 

11 during transport at the level of care and scope 

12 of practice of a hospital emergency department, 

13 including— 

14 ‘‘(i) standards that require the air 

15 ambulance to— 

16 ‘‘(I) be equipped with a ventilator 

17 fully capable of volume or pressure 

18 modes of ventilation; and 

19 ‘‘(II) be equipped with multiple 

20 infusion pumps and use a pharma21 ceutical formulary; 

22 ‘‘(ii) standards that require the air 

23 ambulance and, as needed, medical per24 sonnel to have the capability to conduct 

25 invasive patient monitoring; and 


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1 ‘‘(iii) standards for advanced quali2 fications, capability, and training of med3 ical personnel of the air ambulance (such 

4 as standards for monitoring high-risk pa5 tients, managing critical care pharma6 ceuticals and blood, and point of care blood 

7 testing). 

8 ‘‘(D) LEVEL I CRITERIA DESCRIBED.—In 

9 the case of accreditation of an air ambulance of 

10 a supplier or provider as a level I air ambu11 lance, the criteria described in subparagraph 

12 (A) shall include the capability to provide care 

13 during transport at the level of care and scope 

14 of practice of a tertiary level intensive care unit, 

15 including— 

16 ‘‘(i) standards that require the air 

17 ambulance and, as needed, medical per18 sonnel— 

19 ‘‘(I) to have the capability to 

20 transport specialty care patients (in21 cluding those on intra-aortic balloon 

22 pumps, extracorporeal membrane oxy23 genation, ventrical assist devices, or 

24 isolettes and high-risk obstetric pa25 tients); 


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1 ‘‘(II) to have the capability to 

2 provide critical care transport for an 

3 adult patient for not less than 100 

4 miles without refueling; and 

5 ‘‘(III) to have within the medical 

6 bay of the air ambulance sufficient 

7 space and the capability to provide, as 

8 needed, either 3 person teams (such 

9 as in the case of patients with a 

10 ventrical assist device or patients 

11 needing critical care services) or to 

12 provide care for 2 patients needing 

13 critical care services simultaneously; 

14 ‘‘(ii) standards for sufficient power, 

15 configuration, and design of the medical 

16 bay of the air ambulance to provide critical 

17 care services during transport without de18 laying transport or compromising electrical 

19 systems supporting medical devices; and 

20 ‘‘(iii) standards that require the air 

21 ambulance to be equipped with multiple in22 fusion pumps and use a pharmaceutical 

23 formulary consistent with critical care pro24 vided in a tertiary level intensive care unit. 


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1 ‘‘(E) REQUIREMENTS.—The Secretary 

2 shall consider the following in establishing cri3 teria under subparagraph (A): 

4 ‘‘(i) Ensuring that the criteria de5 scribed in such subparagraph does not ad6 versely impact access to air ambulances for 

7 individuals, particularly in rural areas. 

8 ‘‘(ii) The needs of— 

9 ‘‘(I) suppliers and providers of 

10 air ambulance services located in a 

11 rural area (as defined in section 

12 1886(d)(2)(D)); and 

13 ‘‘(II) air ambulances owned and 

14 operated by units of State or local 

15 government. 

16 ‘‘(iii) The extent to which each of the 

17 criteria is economically feasible, particu18 larly in rural areas (as so defined). 

19 ‘‘(iv) The extent to which each of the 

20 criteria is technically feasible, as well as 

21 market availability and future development 

22 of equipment and products that can be in23 stalled on or carried aboard existing air24 craft. 


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1 ‘‘(v) The incorporation of appropriate 

2 implementation timeframes for the criteria 

3 in a manner that does not impede access, 

4 particularly in rural areas (as so defined). 

5 ‘‘(vi) Ensuring that the criteria is de6 veloped and established through a trans7 parent process with the input of stake8 holders. 

9 ‘‘(vii) Ensuring that the criteria in10 cludes a requirement that the supplier or 

11 provider of air ambulance services follows 

12 an internal policy that provides clear direc13 tion on the distribution to and receipt of 

14 gifts from referring individuals or entities, 

15 including clear limitations on the provision 

16 of such gifts beyond those of nominal 

17 value. 

18 ‘‘(viii) Ensuring regular updating of 

19 the criteria. 

20 ‘‘(5) EXCEPTION.—During the 3-year period 

21 beginning on the effective date of the accreditation 

22 requirement under paragraph (1)(B), the Secretary 

23 shall exempt an air ambulance of a supplier or pro24 vider from such accreditation requirement if the ap25 plication of such requirement to the air ambulance 


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1 would require the supplier or provider to replace its 

2 air ambulance or would impose on the supplier or 

3 provider an undue economic burden with respect to 

4 compliance costs. 

5 ‘‘(6) DATA COLLECTION REQUIREMENTS.—The 

6 Secretary shall establish the following requirements 

7 for the collection of data related to the utilization of 

8 such services: 

9 ‘‘(A) The establishment of protocols for the 

10 collection and reporting of data by the supplier 

11 or provider of air ambulance services regarding 

12 patient transport provided from the scene of an 

13 incident and during an inter-hospital transfer, 

14 including information regarding— 

15 ‘‘(i) patient on-board mileage for 

16 ground and air transport; and 

17 ‘‘(ii) the involvement of ground ambu18 lance transportation in any portions or 

19 segments of the transportation of the pa20 tient. 

21 ‘‘(B) The collection and reporting of infor22 mation obtained via data use agreements with 

23 receiving institutions regarding the rates of dis24 charge from the hospital emergency department 

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1 cluding assessment of injury and illness to de2 scribe utilization appropriateness. 

3 ‘‘(C) The collection and reporting of infor4 mation regarding the extent to which air ambu5 lance transports, other than those by specialized 

6 pediatric and newborn transport teams, are to 

7 receiving institutions with whom the supplier or 

8 provider of air ambulance services is affiliated 

9 or has a contractual arrangement for receiving 

10 hospital destination. 

11 ‘‘(7) DEFINITION OF AIR AMBULANCE SERV12 ICE.—For purposes of this subsection, the term ‘air 

13 ambulance service’ means a fixed wing or a rotary 

14 wing air ambulance service.’’. 

15 (b) CONFORMING AMENDMENTS.—Section 1862(a) 

16 of the Social Security Act (42 U.S.C. 1395y(a)) is amend17 ed— 

18 (1) in paragraph (24), by striking ‘‘or’’ at the 

19 end; 

20 (2) in paragraph (25), by striking the period at 

21 the end and inserting ‘‘; or’’; and 

22 (3) by adding at the end the following new 

23 paragraph: 

24 ‘‘(26) beginning with the date that is 2 years 

25 after the date of enactment of the Air Ambulance 


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1 Medicare Accreditation and Accountability Act, 

2 which are air ambulance services (as defined in sec3 tion 1834(p)(7)) for which payment is made under 

4 the fee schedule established under section 1834(l) 

5 and that are furnished by a supplier or provider (di6 rectly or under an arrangement described in section 

7 1834(l)(1)), if the requirements described in section 

8 1834(p)(1) are not met.’’. 

9 (c) RELATIONSHIP TO STATE LICENSURE REQUIRE10 MENTS.— 

11 (1) IN GENERAL.—Nothing in this Act or the 

12 amendments made by this Act shall affect any re13 quirement that a supplier or provider of air ambu14 lance services comply with State or local laws gov15 erning the licensing and certification of such sup16 plier or provider, an air ambulance, or the medical 

17 personnel of an air ambulance. 

18 (2) PREEMPTION.—Nothing in this Act or the 

19 Amendments made by this Act shall preempt a State 

20 or local government from establishing licensure or 

21 other requirements for suppliers or providers of air 

22 ambulance services that exceed the criteria estab23 lished by the Secretary of Health and Human Serv24 ices for purposes of accreditation of air ambulances 

25 under section 1834(p) of the Social Security Act, as 


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1 added by subsection (a), except to the extent that 

2 the requirement directly conflicts with a requirement 

3 under such subsection or other applicable Federal 

4 law. 

5 SEC. 3. REIMBURSEMENT FOR AIR AMBULANCE SERVICES 

6 UNDER MEDICAID. 

7 Section 1903(i) of the Social Security Act (42 U.S.C. 

8 1396b(i)), as amended by section 2001(a)(2)(B) of the 

9 Patient Protection and Affordable Care Act (Public Law 

10 111–148), is amended— 

11 (1) in paragraph (25), by striking ‘‘or’’ at the 

12 end; 

13 (2) in paragraph (26), by striking the period at 

14 the end and inserting ‘‘; or’’; and 

15 (3) by inserting after paragraph (26) the fol16 lowing new paragraph: 

17 ‘‘(27) with respect to amounts expended for the 

18 transport by an air ambulance of a patient, in an 

19 emergency or nonemergency situation (in this para20 graph referred to as ‘air ambulance services’), or for 

21 any medical services provided to the patient in the 

22 course of such transport, unless— 

23 ‘‘(A) not later than 180 days after the date 

24 of enactment of this paragraph, the State sub25 mits a State plan amendment to the Secretary 


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1 that describes the State’s licensing and regu2 latory requirements for the provision of air am3 bulance services within the State, including— 

4 ‘‘(i) such requirements relating to the 

5 provision of medical services in the course 

6 of transport by air ambulance; 

7 ‘‘(ii) the State’s medically-related use 

8 and dispatch protocols for air ambulance 

9 services; 

10 ‘‘(iii) whether the State imposes min11 imum service requirements described under 

12 section 1834(p)(4)(B)(ii); and 

13 ‘‘(iv) any other relevant information, 

14 as determined appropriate by the Sec15 retary; and 

16 ‘‘(B) not later than January 1, 2015, the 

17 State certifies to the Secretary that the State’s 

18 licensing and regulatory requirements for the 

19 provision of air ambulance services within the 

20 State comply with national guidelines published 

21 by the Federal Interagency Committee on 

22 Emergency Medical Services for the use and 

23 dispatch of air ambulance services.’’. 


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1 SEC. 4. REIMBURSEMENT FOR AIR AMBULANCE SERVICES 

2 UNDER MEDICARE. 

3 (a) IN GENERAL.—Section 1834(l) of the Social Se4 curity Act (42 U.S.C. 1395m(l)) is amended by adding 

5 at the end the following new paragraph: 

6 ‘‘(15) PAYMENT FOR AIR AMBULANCE SERV7 ICES.— 

8 ‘‘(A) IN GENERAL.—In the case of air am9 bulance services furnished on or after the date 

10 that is 2 years after the date of enactment of 

11 the Air Ambulance Medicare Accreditation and 

12 Accountability Act (or, if the Secretary deter13 mines additional time is necessary, such other 

14 date (but not later than 3 years after such date 

15 of enactment) as the Secretary specifies) the 

16 Secretary shall establish a revised air ambu17 lance rate structure under the fee schedule 

18 under this subsection in accordance with the 

19 succeeding provisions of this paragraph. 

20 ‘‘(B) OBJECTIVES.—Revisions to the fee 

21 schedule under this subsection pursuant to this 

22 paragraph shall be limited to changes intended 

23 to accomplish the following objectives: 

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1 ices at higher levels of accreditation under 

2 subsection (p). 

3 ‘‘(ii) Promote quality care. 

4 ‘‘(iii) Preserve timely access to air 

5 ambulance services in those geographic 

6 areas that receive air ambulance services 

7 as of such date of enactment and 

8 incentivize the provision of such services in 

9 geographic areas that are unserved or un10 derserved. 

11 ‘‘(C) CONSIDERATION OF RELATIVE COST

12 OF SERVICES.— 

13 ‘‘(i) IN GENERAL.—Subject to clause 

14 (ii) and subparagraph (D), revisions to the 

15 fee schedule under this subsection pursu16 ant to this paragraph shall provide for 

17 higher levels of reimbursement for the 

18 transport of an individual as follows: 

19 ‘‘(I) Air ambulance services pro20 vided by an air ambulance that is ac21 credited under subsection (p) as a 

22 level II air ambulance shall be reim23 bursed at a higher rate than such 

24 services provided by an air ambulance 


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1 that is accredited under such sub2 section as a level III air ambulance. 

3 ‘‘(II) Air ambulance services pro4 vided by an air ambulance that is ac5 credited under subsection (p) as a 

6 level I air ambulance shall be reim7 bursed at a higher rate than such 

8 services provided by an air ambulance 

9 that is accredited under such sub10 section as a level II air ambulance. 

11 ‘‘(ii) REQUIREMENTS.—The Secretary 

12 shall ensure that the revisions under clause 

13 (i)— 

14 ‘‘(I) reflect an assessment of the 

15 relative differential in the cost of care 

16 provided by air ambulances with dif17 fering levels of accreditation under 

18 subsection (p); and 

19 ‘‘(II) do not alter any adjust20 ments related to providing services in 

21 rural areas or accounting for geo22 graphic differences in cost as provided 

23 under the fee schedule under this sub24 section as of the date of enactment of 

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1 tation and Accountability Act, includ2 ing any increase in payments under 

3 paragraph (12) or (13). 

4 ‘‘(D) SOLE COMMUNITY AIR AMBULANCE

5 SERVICES.— 

6 ‘‘(i) IN GENERAL.—Under such re7 vised air ambulance rate structure, air am8 bulance services provided by a sole commu9 nity air ambulance for which the transport 

10 originates in a rural area (as defined in 

11 section 1886(d)(2)(D)) with a Rural12 Urban Commuting Area code of level 7 or 

13 higher shall be reimbursed at a higher rate 

14 than such services provided by an air am15 bulance that is accredited under subsection 

16 (p) at the same level as the sole commu17 nity air ambulance but which is not a sole 

18 community air ambulance. 

19 ‘‘(ii) DEFINITION OF SOLE COMMU20 NITY AIR AMBULANCE.—In this paragraph, 

21 the term ‘sole community air ambulance’ 

22 means an air ambulance that serves a 

23 rural area (as defined in section 

24 1886(d)(2)(D)) with a low population den25 sity and is a distance of not less than 100 


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1 air statute miles from the base of oper2 ation of any other air ambulance. 

3 ‘‘(E) MITIGATION OF POTENTIAL IMPACTS

4 ON ACCESS TO SERVICES.—The Secretary shall, 

5 prior to the implementation of the revised air 

6 ambulance rate structure under this paragraph, 

7 modify any potential revisions in payment rates 

8 under such revised air ambulance rate structure 

9 as necessary to ensure that such revisions do 

10 not adversely impact current access to air am11 bulance services, particularly in rural and un12 derserved areas, including by— 

13 ‘‘(i) providing for a reasonable transi14 tion period to the revised air ambulance 

15 rate structure, including through the use 

16 of payment floors for each year of the 

17 transition period; 

18 ‘‘(ii) limiting changes in such payment 

19 rates based on the assessment of relative 

20 costs; and 

21 ‘‘(iii) taking into consideration the ca22 pacities, volume, and special circumstances 

23 of— 

24 ‘‘(I) suppliers or providers of air 

25 ambulance services located in a rural 


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1 area (as defined in section 

2 1886(d)(2)(D)); and 

3 ‘‘(II) air ambulances owned and 

4 operated by units of State or local 

5 government. 

6 ‘‘(F) CONSULTATION.—The Secretary shall 

7 consult with all relevant stakeholders in estab8 lishing the revised air ambulance rate structure 

9 under this paragraph. 

10 ‘‘(G) INDEPENDENT COST STUDY.—In es11 tablishing such revised air ambulance rate 

12 structure, the Secretary shall use a cost anal13 ysis conducted by an independent organization 

14 under a contract with the Secretary. 

15 ‘‘(H) BUDGET NEUTRALITY.—Revisions in 

16 payment implemented pursuant to this para17 graph shall result in the same estimated 

18 amount of aggregate expenditures under this 

19 title for air ambulance services furnished in the 

20 fiscal year in which such revisions in payment 

21 are implemented and each subsequent year as 

22 would have been made under this title for such 

23 care in such fiscal year and each such subse24 quent year if such revisions had not been imple25 mented. For purposes of applying the preceding 


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1 sentence, the Secretary shall take into account 

2 any updates or other adjustments applicable to 

3 payments for such services or increases in utili4 zation of such services expected as of the date 

5 of enactment of the Air Ambulance Medicare 

6 Accreditation and Accountability Act. 

7 ‘‘(I) NONCOVERAGE EVENT.—Not later 

8 than 180 days after the date of enactment of 

9 the Air Ambulance Medicare Accreditation and 

10 Accountability Act, the Secretary shall establish 

11 noncoverage events for which reimbursement 

12 for air ambulance services will not be provided 

13 under this subsection. Such noncoverage events 

14 shall include the following: 

15 ‘‘(i) Patient death or serious disability 

16 caused by loss of oxygen supply. 

17 ‘‘(ii) Patient or passenger death or se18 rious disability caused by emergency med19 ical transportation vehicle failure or crash. 

20 ‘‘(iii) Patient death or serious dis21 ability caused by transport to an unin22 tended destination. 

23 ‘‘(iv) Responding without a formal re24 quest by emergency medical services or 

25 hospital personnel. 


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1 ‘‘(v) Patient death or serious dis2 ability caused by dropping a patient or al3 lowing a fall. 

4 ‘‘(vi) Death or serious disability to 

5 emergency medical services personnel or a 

6 patient caused by the failure of the emer7 gency medical transportation vehicle to 

8 communicate an initial estimated time of 

9 arrival or delays. 

10 ‘‘(J) DEFINITION OF AIR AMBULANCE

11 SERVICE.—In this paragraph, the term ‘air am12 bulance service’ has the meaning given that 

13 term in subsection (p)(7).’’. 

14 (b) CONFORMING AMENDMENT.—Section 

15 1862(a)(26) of the Social Security Act, as added by sec16 tion 2(b), is amended by inserting ‘‘, or (beginning with 

17 the date that is 180 days after the date of enactment of 

18 the Air Ambulance Medicare Accreditation and Account19 ability Act) in the case where the Secretary determines 

20 that a noncoverage event established under section 

21 1834(l)(15)(I) has occurred in the furnishing of such serv22 ice’’ before the period at the end. 


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1 SEC. 5. AIR AMBULANCE QUALITY DATA REPORTING PRO2 GRAM. 

3 Section 1834(l) of the Social Security Act (42 U.S.C. 

4 1395m(l)), as amended by section 4, is amended— 

5 (1) in paragraph (3)(B), by striking ‘‘subpara6 graph (C)’’ and inserting ‘‘subparagraph (C) and 

7 paragraph (16)’’; and 

8 (2) by adding at the end the following new 

9 paragraph: 

10 ‘‘(16) AIR AMBULANCE QUALITY DATA REPORT11 ING PROGRAM.— 

12 ‘‘(A) REDUCTION IN UPDATE FOR FAILURE

13 TO REPORT.— 

14 ‘‘(i) IN GENERAL.—For each year (be15 ginning with January 1 following the date 

16 that is 3 years after the date of enactment 

17 of the Air Ambulance Medicare Accredita18 tion and Accountability Act), in the case of 

19 a supplier or provider of air ambulance 

20 services that does not submit data to the 

21 Secretary in accordance with subparagraph 

22 (C) with respect to such year, after deter23 mining the percentage increase under 

24 paragraph (3)(B), and after application of 

25 paragraph (3)(C), the Secretary shall re26 duce such percentage increase for payVerDate Mar 15 2010 00:44 Jul 23, 2011 Jkt 099200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\S1407.IS S1407

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1 ments under the fee schedule under this 

2 subsection during such year by 0.4 per3 centage points (or, beginning with January 

4 1 following the date that is 5 years after 

5 such date of enactment, 2.0 percentage 

6 points). 

7 ‘‘(ii) SPECIAL RULE.—The application 

8 of this subparagraph may result in such 

9 percentage increase being less than 0.0 for 

10 a year, and may result in payment rates 

11 under the fee schedule under this sub12 section for a year being less than such pay13 ment rates for the preceding year. 

14 ‘‘(B) NONCUMULATIVE APPLICATION.— 

15 Any reduction under subparagraph (A) shall 

16 apply only with respect to the year involved and 

17 the Secretary shall not take into account such 

18 reduction in computing the payment amount 

19 under the fee schedule under this subsection for 

20 a subsequent year. 

21 ‘‘(C) SUBMISSION OF QUALITY DATA.—For 

22 each year (beginning with January 1 following 

23 the date that is 3 years after the date of enact24 ment of the Air Ambulance Medicare Accredita25 tion and Accountability Act), each supplier or 


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1 provider of air ambulance services shall submit 

2 to the Secretary data on quality measures speci3 fied under subparagraph (D). Such data shall 

4 be submitted in a form and manner, and at a 

5 time, specified by the Secretary for purposes of 

6 this subparagraph. 

7 ‘‘(D) QUALITY MEASURES.— 

8 ‘‘(i) IN GENERAL.—The Secretary 

9 shall specify quality measures for each ac10 creditation level for air ambulances under 

11 subsection (p) that reflect the capability of 

12 the air ambulance to deliver such services 

13 equal to each such accreditation level. Sub14 ject to clause (ii), any measure specified by 

15 the Secretary under this subparagraph 

16 must have been endorsed by the entity 

17 with a contract under section 1890(a). 

18 ‘‘(ii) EXCEPTION.—In the case of a 

19 specified area or medical topic determined 

20 appropriate by the Secretary for which a 

21 feasible and practical measure has not 

22 been endorsed by the entity with a contract 

23 under section 1890(a), the Secretary may 

24 specify a measure that is not so endorsed 

25 as long as due consideration is given to 


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1 measures that have been endorsed or 

2 adopted by a consensus organization iden3 tified by the Secretary. 

4 ‘‘(iii) TIME FRAME.—Not later than 2 

5 years after the date of enactment of the 

6 Air Ambulance Medicare Accreditation and 

7 Accountability Act, the Secretary shall 

8 publish the measures selected under this 

9 subparagraph that will be applicable with 

10 respect to the year beginning on January 

11 1 following the date that is 3 years after 

12 such date of enactment. 

13 ‘‘(iv) UPDATING MEASURES SPECI14 FIED.— 

15 ‘‘(I) IN GENERAL.—The Sec16 retary may, by regulation, revise qual17 ity measures specified under this sub18 paragraph on an annual basis. 

19 ‘‘(II) CONSULTATION.—The Sec20 retary shall consult with relevant 

21 stakeholders in revising quality meas22 ures under subclause (I). 

23 ‘‘(E) PUBLIC AVAILABILITY OF DATA SUB24 MITTED.—The Secretary shall establish proce25 dures for making data submitted under subVerDate Mar 15 2010 00:44 Jul 23, 2011 Jkt 099200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\S1407.IS S1407

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1 paragraph (C) available to the public. Such pro2 cedures shall ensure that a supplier or provider 

3 of air ambulance services has the opportunity to 

4 review the data that is to be made public with 

5 respect to the supplier or provider prior to such 

6 data being made public. The Secretary shall re7 port quality measures that relate to air ambu8 lance services on the Internet website of the 

9 Centers for Medicare & Medicaid Services. 

10 ‘‘(F) IMPLEMENTATION.— 

11 ‘‘(i) IN GENERAL.—The Secretary 

12 shall promulgate regulations to carry out 

13 this paragraph. 

14 ‘‘(ii) CONSULTATION.—The Secretary 

15 shall consult with relevant stakeholders in 

16 promulgating regulations under clause 

17 (i).’’. 

18 SEC. 6. STUDY AND REPORT BY THE INSTITUTE OF MEDI19 CINE ON GROUND CRITICAL CARE TRANS20 PORT. 

21 (a) IN GENERAL.—The Secretary of Health and 

22 Human Services is authorized to enter into an agreement 

23 with the Institute of Medicine of the National Academies 

24 to conduct a study on ground critical care transport that 

25 identifies the following: 


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1 (1) Any barriers to effective use of ground crit2 ical care transport. 

3 (2) Any design issues with respect to emergency 

4 medical transportation vehicles that may affect pa5 tient and crew safety. 

6 (3) Any issues with respect to reimbursement 

7 for such services under the Medicare program under 

8 title XVIII of the Social Security Act (42 U.S.C. 

9 1395 et seq.) that may affect the high quality of 

10 care and expeditious transport provided by ground 

11 critical care ambulances. 

12 (b) REPORT.—An agreement entered into under sub13 section (a) shall provide for the Institute of Medicine to 

14 submit to the Secretary of Health and Human Services 

15 and to Congress a report containing the results of the 

16 study conducted under such subsection. 

Æ 


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