I 

111TH CONGRESS 

1ST SESSION H. R. 978 

To recognize and clarify the authority of the States to regulate intrastate 

helicopter medical services pursuant to their authority over public health 

planning and protection, patient safety and protection, emergency medical 

services, the quality and coordination of medical care, and the practice 

of medicine within their jurisdictions. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 11, 2009 

Mr. ALTMIRE (for himself, Mrs. MILLER of Michigan, Mr. CLEAVER, Mr. 

HOLDEN, Mr. MASSA, Mr. PLATTS, Ms. PINGREE of Maine, Mr. SHULER, 

Mr. PETERSON, Mr. SPACE, Mr. EHLERS, Mr. MCINTYRE, Mr. CAPUANO, 

and Mr. MICHAUD) 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 intrastate helicopter medical services pursuant to 

their authority over public health planning and protection, patient safety and protection, emergency medical 

services, 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 ‘‘Helicopter Medical 

3 Services Patient Safety, Protection, and Coordination 

4 Act’’. 

5 SEC. 2. FINDINGS. 

6 Congress finds the following: 

7 (1) The Federal Aviation Administration is re8 sponsible for regulating civil aviation in the United 

9 States. 

10 (2) Each State is responsible for the regulation 

11 of public health planning and protection, patient 

12 safety and protection, emergency medical services, 

13 the quality and coordination of medical care, and the 

14 practice of medicine within its jurisdiction. 

15 (3) Helicopter medical services are an essential 

16 component of the health care delivery and emergency 

17 medical services system in each State and integral to 

18 each State’s management of public health planning 

19 and protection, patient safety and protection, emer20 gency medical services, the quality and coordination 

21 of medical care, and the practice of medicine within 

22 its jurisdiction. 

23 (4) Existing or future regulation of helicopter 

24 medical services by the several States is in the public 

25 interest. 


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1 (5) Court rulings and statutory interpretations 

2 issued by the Department of Transportation have 

3 imposed limitations on the authority of States to 

4 regulate helicopter medical services in a manner 

5 similar to the regulation of other health care services 

6 by the States. 

7 (6) These rulings and interpretations have con8 cluded that certain State actions related to public 

9 health planning and protection, patient safety and 

10 protection, emergency medical services, the quality 

11 and coordination of medical care, and the practice of 

12 medicine and related aspects of helicopter medical 

13 services are preempted by Federal law, either pursu14 ant to the preemption provisions of the Airline De15 regulation Act of 1978 or through the application of 

16 the ‘‘field occupation’’ preemption doctrine. 

17 (7) The Airline Deregulation Act of 1978 did 

18 not contemplate helicopter medical services, and the 

19 use of the Act to strike down intrastate health-re20 lated regulations overseeing helicopter medical serv21 ices that would otherwise be permissible with respect 

22 to any other segment of the health care industry is 

23 not in the public interest. 

24 (8) At the same time, it is also important to en25 sure that the Federal Aviation Administration’s pleVerDate Nov 24 2008 21:41 Feb 12, 2009 Jkt 079200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H978.IH H978

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1 nary and exclusive jurisdiction over matters of avia2 tion safety is not infringed by any State and that 

3 State health-related regulation of helicopter medical 

4 services is harmonized with Federal regulation of 

5 aviation safety. 

6 (9) Accordingly, there is a need for clarification 

7 of existing Federal law so that States may regulate 

8 helicopter medical services with respect to public 

9 health planning and protection, patient safety and 

10 protection, emergency medical services, the quality 

11 and coordination of medical care, and the practice of 

12 medicine without infringing on the Federal govern13 ment’s plenary power to regulate aviation safety. 

14 SEC. 3. CLARIFICATION OF STATE AUTHORITY OVER 

15 INTRASTATE HELICOPTER MEDICAL SERV16 ICES. 

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

18 States Code, is amended by adding at the end the fol19 lowing: 

20 ‘‘§ 40130. Clarification of State authority over intra21 state helicopter medical services 

22 ‘‘(a) CLARIFICATION OF STATE AUTHORITY.—Noth23 ing in this subtitle shall prohibit a State from regulating 

24 helicopter medical services provided between locations 

25 within such State (or helicopter medical services provided 


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1 between locations in more than one State if undertaken 

2 pursuant to an agreement between or among such States) 

3 in the manner described in subsection (b), (c), or (d). 

4 ‘‘(b) STATE AUTHORITY OVER MEDICAL SERV5 ICES.—A State may regulate helicopter medical services 

6 with respect to the following: 

7 ‘‘(1) The medical qualifications and medical 

8 training of helicopter medical personnel, except that 

9 a State shall not impose new or additional require10 ments on a pilot. 

11 ‘‘(2) The obligation of providers of helicopter 

12 medical services to comply with the health planning, 

13 patient safety, and medical service requirements of 

14 a State, including— 

15 ‘‘(A) coordination between emergency med16 ical services providers, receiving institutions, 

17 and other medical transport service providers 

18 regarding the transport of a patient; 

19 ‘‘(B) demonstration of adequate capacity 

20 to provide helicopter medical services; 

21 ‘‘(C) demonstration of the need for new or 

22 expanded helicopter medical services; 

23 ‘‘(D) limitations on the number of heli24 copters providing helicopter medical services 

25 within the State or region of the State; 


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1 ‘‘(E) affiliation with health care institu2 tions; 

3 ‘‘(F) sanitation and infection control proto4 cols; 

5 ‘‘(G) medical records requirements; 

6 ‘‘(H) quality requirements, including par7 ticipation in patient safety and medical quality 

8 control efforts, such as peer review processes, 

9 utilization review, and error reporting systems; 

10 and 

11 ‘‘(I) the provision of emergency helicopter 

12 medical services to all persons for whom such 

13 services are medically necessary and appro14 priate. 

15 ‘‘(c) STATE AUTHORITY OVER MEDICAL SERVICES

16 SUBJECT TO HARMONIZATION REQUIREMENT.—To the 

17 extent that any State regulations are harmonized with any 

18 relevant Federal operating requirements, a State may reg19 ulate helicopter medical services with respect to the fol20 lowing: 

21 ‘‘(1) The designation of destinations for emer22 gency patient transport. 

23 ‘‘(2) The specification of service requirements 

24 with respect to geographic areas within a State or 

25 during specified hours and days. 


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1 ‘‘(3) The coordination of flight requests for 

2 emergency helicopter medical services. 

3 ‘‘(4) Compliance with accreditation require4 ments. 

5 ‘‘(d) STATE AUTHORITY OVER MEDICAL SERVICES

6 SUBJECT TO CONSISTENCY REQUIREMENT.—To the ex7 tent that any State regulations are consistent with any 

8 relevant Federal operating requirements (such as air9 worthiness and the proper storage and installation of med10 ical equipment) applicable to a helicopter that is otherwise 

11 capable of meeting such State regulations, a State may 

12 regulate helicopter medical services with respect to the fol13 lowing: 

14 ‘‘(1) The necessary medical equipment to be 

15 carried on board or affixed to the helicopter. 

16 ‘‘(2) The physical attributes of the helicopter— 

17 ‘‘(A) necessary for the provision of quality 

18 medical care, including— 

19 ‘‘(i) climate control; 

20 ‘‘(ii) a configuration that allows ade21 quate access to the patient, medical equip22 ment, and medical supplies by the heli23 copter medical personnel; 


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1 ‘‘(iii) use of materials in the helicopter 

2 that are appropriate for proper patient 

3 care; and 

4 ‘‘(iv) sufficient electrical supply to 

5 support medical equipment without com6 promising helicopter power; and 

7 ‘‘(B) necessary for the protection of heli8 copter and ground medical personnel. 

9 ‘‘(3) Communication capabilities enabling— 

10 ‘‘(A) the helicopter personnel to commu11 nicate with emergency medical services and 

12 public safety personnel and personnel at receiv13 ing institutions; and 

14 ‘‘(B) the flightcrew to communicate with 

15 the helicopter medical personnel. 

16 ‘‘(e) DEFINITIONS.—In this section, the following 

17 definitions apply: 

18 ‘‘(1) HELICOPTER MEDICAL SERVICES.—The 

19 term ‘helicopter medical services’ means the heli20 copter transport of a patient, in both emergency and 

21 nonemergency situations, as well as the medical 

22 services provided to such patient in the course of 

23 transport by such helicopter. 

24 ‘‘(2) FEDERAL OPERATING REQUIREMENTS.— 

25 The term ‘Federal operating requirements’ means 


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1 requirements under part A of subtitle VII of title 

2 49, United States Code, and Federal aviation regu3 lations set forth in title 14, Code of Federal Regula4 tions.’’. 

5 (b) CONFORMING AMENDMENT.—The analysis for 

6 such chapter is amended by adding at the end the fol7 lowing: 

‘‘Sec. 40130. Clarification of State authority over intrastate helicopter medical 

services.’’. 

Æ 


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