I 

112TH CONGRESS 

1ST SESSION H. R. 1117 

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. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 16, 2011 

Mrs. MILLER of Michigan (for herself and Mr. ALTMIRE) introduced the following bill; which was referred to the Committee on Transportation and 

Infrastructure, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in 

each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

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. 

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


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Air Ambulance Patient 

3 Safety, Protection, and Coordination Act’’. 

4 SEC. 2. CLARIFICATION OF STATE AUTHORITY OVER THE 

5 MEDICAL ASPECTS OF AIR AMBULANCE 

6 SERVICES. 

7 (a) IN GENERAL.—Chapter 401 of title 49, United 

8 States Code, is amended by adding at the end the fol9 lowing: 

10 ‘‘§ 40130. Clarification of State authority over the 

11 medical aspects of air ambulance services 

12 ‘‘(a) CLARIFICATION OF STATE AUTHORITY.—Pursu13 ant to a State’s authority over the licensure and regulation 

14 of health care services within its borders, a State may pre15 scribe licensing and other regulatory requirements related 

16 to the medical aspects of intrastate air ambulance services 

17 in the same manner that it regulates other health care 

18 services within its borders and may integrate such services 

19 into the State’s emergency medical services system, includ20 ing by establishing requirements related to the following: 

21 ‘‘(1) The quality of emergency medical care 

22 provided to patients by air ambulances, including— 

23 ‘‘(A) the medical qualifications and med24 ical training of medical personnel; 

25 ‘‘(B) medical records and data collection 

26 and reporting; 


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1 ‘‘(C) outcome and proficiency measures; 

2 ‘‘(D) affiliation with health care institu3 tions for medical oversight, critical care medical 

4 education, and clinical experience in critical 

5 care settings; 

6 ‘‘(E) participation in patient safety and 

7 quality control initiatives, such as peer review, 

8 utilization review, and error reporting; 

9 ‘‘(F) medical accreditation; 

10 ‘‘(G) licensing of personnel including scope 

11 of practice and credentialing; and 

12 ‘‘(H) medical oversight. 

13 ‘‘(2) The availability of air ambulance services 

14 provided to patients with emergency medical condi15 tions, including— 

16 ‘‘(A) service during specified hours and 

17 days to ensure the availability of life-saving 

18 medical services as part of the State’s emer19 gency medical services system; and 

20 ‘‘(B) coordination of services, agreements, 

21 and flight requests for patients with emergency 

22 medical conditions being transported from the 

23 scene at which the patient’s injury or accident, 

24 or other event resulting in the need for medical 

25 services for the patient, occurred. 


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1 ‘‘(3) Communication between— 

2 ‘‘(A) emergency medical and public safety 

3 agencies and hospitals; and 

4 ‘‘(B) the flightcrew and air ambulance 

5 medical personnel to the extent that the com6 munications do not interfere with the safe oper7 ation of the flight. 

8 ‘‘(4) The accessibility of emergency medical 

9 care provided by air ambulances and the incorpora10 tion and integration of air ambulance services into 

11 State emergency medical services systems, includ12 ing— 

13 ‘‘(A) access to air ambulance services in 

14 regions of a State; 

15 ‘‘(B) the provision of services to all per16 sons for whom such services are medically nec17 essary and appropriate regardless of ability to 

18 pay; 

19 ‘‘(C) the proffer of gifts of monetary value 

20 to referring entities; 

21 ‘‘(D) medical criteria, based on the pa22 tient’s medical need for transport from the 

23 scene at which the patient’s injury or accident, 

24 or other event resulting in the need for medical 


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1 services for the patient occurred, for deter2 mining the appropriate— 

3 ‘‘(i) mode of transport (ground versus 

4 air) utilizing evidence-based triage criteria 

5 to the extent available; 

6 ‘‘(ii) air ambulance to be utilized to 

7 transport a patient in accordance with its 

8 capability to meet the patient’s medical 

9 need; and 

10 ‘‘(iii) medical institution to receive the 

11 patient. 

12 ‘‘(5) The acceptability of air ambulance services 

13 to ensure the adequate and appropriate provision of 

14 medically necessary emergency medical care provided 

15 by air ambulances to protect critically ill and injured 

16 patients, including— 

17 ‘‘(A) medical equipment, devices, and sup18 plies to be carried on board or affixed to the air 

19 ambulance; 

20 ‘‘(B) sanitation and infection control; 

21 ‘‘(C) licensing of the air ambulance agency 

22 or program; 

23 ‘‘(D) licensing of the ambulance vehicle; 

24 ‘‘(E) truth in advertising requirements; 


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1 ‘‘(F) physical attributes of the air ambu2 lance necessary for the provision of quality 

3 medical care, including— 

4 ‘‘(i) permanently installed climate con5 trol systems capable of meeting specified 

6 temperature settings; 

7 ‘‘(ii) a configuration that allows ade8 quate access to the patient, medical equip9 ment, and medical supplies by the medical 

10 personnel; 

11 ‘‘(iii) the use of materials in the air 

12 ambulance that are appropriate for proper 

13 patient care; 

14 ‘‘(iv) sufficient electrical supply to 

15 support medical equipment without com16 promising the ambulance power; and 

17 ‘‘(v) the ability of the air ambulance 

18 to transport a patient a certain distance 

19 without refueling within the State. 

20 ‘‘(6) Physical attributes of the air ambulance 

21 necessary— 

22 ‘‘(A) for the protection of the ambulance, 

23 ground, and emergency response personnel; and 

24 ‘‘(B) to ensure that the air ambulance has 

25 no structural or functional defects that may adVerDate Mar 15 2010 02:11 Mar 17, 2011 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1117.IH H1117

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1 versely affect such personnel, such as by requir2 ing the provision of tailrotor illumination for 

3 loading patients at night or external search 

4 lights. 

5 ‘‘(b) APPLICABILITY OF FEDERAL AVIATION SAFETY

6 AUTHORITY.—No State health-related regulation estab7 lished pursuant to this section shall supersede or be incon8 sistent with any Federal operating requirement with re9 spect to aviation safety. 

10 ‘‘(c) LIMITATIONS.— 

11 ‘‘(1) IN GENERAL.—State requirements and 

12 regulations prescribed pursuant to this section must 

13 be in accordance with objective, competitive, and 

14 transparent processes designed to ensure the highest 

15 quality of emergency medical care and patient safe16 ty, best outcomes, and access to life-saving emer17 gency medical services as part of an integrated 

18 emergency medical services system. 

19 ‘‘(2) PRICES.—This section shall not be con20 strued to allow State regulation of the prices 

21 charged by air ambulances for their services. 

22 ‘‘(3) PROVIDERS LICENSED IN MULTIPLE

23 STATES.—If an air ambulance is licensed to provide 

24 services in more than one State and the regulations 

25 established pursuant to this subsection by the States 


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1 are inconsistent, the provider shall comply with the 

2 most stringent of such regulations. 

3 ‘‘(4) NONDELEGATION REQUIREMENT.—A 

4 State may not delegate authority provided under this 

5 section to a political subdivision of the State. 

6 ‘‘(d) INTERSTATE AGREEMENTS.—In regulating the 

7 provision of air ambulance services pursuant to this sec8 tion, a State shall, if necessary, establish regulations or 

9 negotiate mutual aid agreements with adjacent States or 

10 air ambulances to ensure access to air ambulance services 

11 across State borders. 

12 ‘‘(e) DEFINITIONS.— 

13 ‘‘(1) AIR AMBULANCE SERVICES.—The term 

14 ‘air ambulance services’ means the transport by an 

15 air ambulance of a patient, in both emergency and 

16 nonemergency situations, as well as the medical 

17 services provided to such patient in the course of 

18 transport by such air ambulance. 

19 ‘‘(2) FEDERAL OPERATING REQUIREMENTS.— 

20 The term ‘Federal operating requirements’ means 

21 requirements under part A of subtitle VII of title 

22 49, United States Code, and Federal aviation regu23 lations set forth in title 14, Code of Federal Regula24 tions. 


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1 ‘‘(3) REFERRING ENTITIES.—The term ‘refer2 ring entity’ means any entity that dispatches or pro3 vides a referral for a provider of air ambulance serv4 ices, such as a medical institution, an agency pro5 viding emergency medical services, or a first re6 sponder.’’. 

7 (b) CONFORMING AMENDMENT.—The analysis for 

8 such chapter is amended by adding at the end the fol9 lowing: 

‘‘40130. Clarification of State authority over the medical aspects of air ambulance services.’’. 

Æ 


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