H. R. 302—150 
(c) CONSULTATION.—The advisory committee shall, as appro-
priate, consult with relevant experts and stakeholders not captured 
in (b) while conducting its review. 
(d) RECOMMENDATIONS.—The advisory committee shall make 
recommendations with respect to disclosure of charges and fees 
for air ambulance services and insurance coverage, consumer protec-
tion and enforcement authorities of both the Department of 
Transportation and State authorities, and the prevention of balance 
billing to consumers. The recommendations shall address, at a 
minimum— 
(1) the costs, benefits, practicability, and impact on all 
stakeholders of clearly distinguishing between charges for air 
transportation services and charges for non-air transportation 
services in bills and invoices, including the costs, benefits, 
and practicability of— 
(A) developing cost-allocation methodologies to sepa-
rate charges for air transportation services from charges 
for non-air transportation services; and 
(B) formats for bills and invoices that clearly distin-
guish between charges for air transportation services and 
charges for non-air transportation services; 
(2) options, best practices, and identified standards to pre-
vent instances of balance billing such as improving network 
and contract negotiation, dispute resolution between health 
insurance and air medical service providers, and explanation 
of insurance coverage and subscription programs to consumers; 
(3) steps that can be taken by State legislatures, State 
insurance regulators, State attorneys general, and other State 
officials as appropriate, consistent with current legal authorities 
regarding consumer protection; 
(4) recommendations made by the Comptroller General 
study, GAO–17–637, including what additional data from air 
ambulance providers and other sources should be collected by 
the Department of Transportation to improve its understanding 
of the air ambulance market and oversight of the air ambulance 
industry for the purposes of pursuing action related to unfair 
or deceptive practices or unfair methods of competition, which 
may include— 
(A) cost data; 
(B) standard charges and payments received per trans-
port; 
(C) whether the provider is part of a hospital-sponsored 
program, municipality-sponsored program, hospital-inde-
pendent partnership (hybrid) program, or independent pro-
gram; 
(D) number of transports per base and helicopter; 
(E) market shares of air ambulance providers inclusive 
of any parent or holding companies; 
(F) any data indicating the extent of competition among 
air ambulance providers on the basis of price and service; 
(G) prices assessed to consumers and insurers for air 
transportation and any non-transportation services pro-
vided by air ambulance providers; and 
(H) financial performance of air ambulance providers; 
(5) definitions of all applicable terms that are not defined 
in statute or regulations; and 
(6) other matters as determined necessary or appropriate.
H. R. 302—151 
(e) REPORT.—Not later than 180 days after the date of the 
first meeting of the advisory committee, the advisory committee 
shall submit to the Secretary of Transportation, the Secretary of 
Health and Human Services, and the appropriate committees of 
Congress a report containing the recommendations made under 
subsection (d). 
(f) RULEMAKING.—Upon receipt of the report under subsection 
(e), the Secretary of Transportation shall consider the recommenda-
tions of the advisory committee and issue regulations or other 
guidance as deemed necessary— 
(1) to require air ambulance providers to regularly report 
data to the Department of Transportation; 
(2) to increase transparency related to Department of 
Transportation actions related to consumer complaints; and 
(3) to provide other consumer protections for customers 
of air ambulance providers. 
(g) ELIMINATION OF ADVISORY COUNCIL ON TRANSPORTATION 
STATISTICS.—The Advisory Council on Transportation Statistics 
shall terminate on the date of enactment of this Act. 
SEC. 419. AIR AMBULANCE COMPLAINTS TO THE DEPARTMENT OF 
TRANSPORTATION. 
(a) CONSUMER COMPLAINTS.—Section 42302 of title 49, United 
States Code, is further amended— 
(1) in subsection (a) by inserting ‘‘(including transportation 
by air ambulance (as defined by the Secretary of Transpor-
tation))’’ after ‘‘air transportation’’; and 
(2) by adding at the end the following: 
‘‘(e) AIR AMBULANCE PROVIDERS.—Each air ambulance provider 
shall include the hotline telephone number, link to the Internet 
website established under subsection (a), and contact information 
for the Aviation Consumer Advocate established under section 425 
on— 
‘‘(1) any invoice, bill, or other communication provided to 
a passenger or customer of the provider; and 
‘‘(2) its Internet Web site, and any related mobile device 
application.’’. 
(b) UNFAIR AND DECEPTIVE PRACTICES AND UNFAIR METHODS 
OF COMPETITION.—Section 41712(a) of title 49, United States Code, 
is amended by inserting ‘‘air ambulance consumer (as defined by 
the Secretary of Transportation),’’ after ‘‘foreign air carrier,’’ in 
the first place it appears. 
SEC. 420. REPORT TO CONGRESS ON AIR AMBULANCE OVERSIGHT. 
(a) IN GENERAL.—Not later than 180 days after submission 
of the report required under section 418, the Secretary of Transpor-
tation shall submit a report to the appropriate committees of Con-
gress on air ambulance oversight. 
(b) CONTENTS
OF REPORT.—The report required under sub-
section (a) shall include— 
(1) a description of how the Secretary will conduct oversight 
of air ambulance providers, including the information sources 
the Secretary will use to conduct such oversight; and 
(2) a timeline for the issuance of any guidance concerning 
unfair and deceptive practices among air ambulance providers, 
including guidance for States and political subdivisions of 
States to refer such matters to the Secretary.
H. R. 302—152 
SEC. 421. REFUNDS FOR OTHER FEES THAT ARE NOT HONORED BY 
A COVERED AIR CARRIER. 
Not later than 1 year after the date of enactment of this 
Act, the Secretary of Transportation shall promulgate regulations 
that require each covered air carrier to promptly provide a refund 
to a passenger of any ancillary fees paid for services related to 
air travel that the passenger does not receive, including on the 
passenger’s scheduled flight, on a subsequent replacement itinerary 
if there has been a rescheduling, or for a flight not taken by 
the passenger. 
SEC. 422. ADVANCE BOARDING DURING PREGNANCY. 
Not later than 180 days after the date of enactment of this 
Act, the Secretary of Transportation shall review air carrier policies 
regarding traveling during pregnancy and, if appropriate, may 
revise regulations, as the Secretary considers necessary, to require 
an air carrier to offer advance boarding of an aircraft to a pregnant 
passenger who requests such assistance. 
SEC. 423. CONSUMER COMPLAINT PROCESS IMPROVEMENT. 
(a) IN GENERAL.—Section 42302(c) of title 49, United States 
Code is amended— 
(1) in the matter preceding paragraph (1), by striking ‘‘An 
air carrier or foreign air carrier providing scheduled air 
transportation using any aircraft that as originally designed 
has a passenger capacity of 30 or more passenger seats’’ and 
inserting ‘‘Each air carrier and foreign air carrier’’; 
(2) in paragraph (1), by striking ‘‘air carrier’’ and inserting 
‘‘carrier’’; and 
(3) in paragraph (2), by striking ‘‘air carrier’’ and inserting 
‘‘carrier’’. 
(b) RULEMAKING.—Not later than 1 year after the date of enact-
ment of this Act, the Secretary of Transportation shall promulgate 
regulations to implement the requirements of section 42302 of title 
49, United States Code, as amended by this Act. 
SEC. 424. AVIATION CONSUMER ADVOCATE. 
(a) IN GENERAL.—The Secretary of Transportation shall review 
aviation consumer complaints received that allege a violation of 
law and, as appropriate, pursue enforcement or corrective actions 
that would be in the public interest. 
(b) CONSIDERATIONS.—In considering which cases to pursue 
for enforcement or corrective action under subsection (a), the Sec-
retary shall consider— 
(1) the Air Carrier Access Act of 1986 (Public Law 99– 
435; 100 Stat. 1080); 
(2) unfair and deceptive practices by air carriers (including 
air ambulance operators), foreign air carriers, and ticket agents; 
(3) the terms and conditions agreed to between passengers 
and air carriers (including air ambulance operators), foreign 
air carriers, or ticket agents; 
(4) aviation consumer protection and tarmac delay contin-
gency planning requirements for both airports and airlines; 
(5) protection of air ambulance consumers; and 
(6) any other applicable law. 
(c) AVIATION CONSUMER ADVOCATE.—
H. R. 302—153 
(1) IN GENERAL.—Within the Aviation Consumer Protection 
Division of the Department of Transportation, there shall be 
an Aviation Consumer Advocate. 
(2) FUNCTIONS.—The Aviation Consumer Advocate shall— 
(A) assist consumers in resolving carrier service com-
plaints filed with the Aviation Consumer Protection Divi-
sion; 
(B) review the resolution by the Department of 
Transportation of carrier service complaints; 
(C) identify and recommend actions the Department 
can take to improve the enforcement of aviation consumer 
protection rules, protection of air ambulance consumers, 
and resolution of carrier service complaints; and 
(D) identify and recommend regulations and policies 
that can be amended to more effectively resolve carrier 
service complaints. 
(d) ANNUAL REPORTS.—The Secretary, through the Aviation 
Consumer Advocate, shall submit to the appropriate committees 
of Congress an annual report summarizing the following: 
(1) The total number of annual complaints received by 
the Department, including the number of complaints by the 
name of each air carrier and foreign air carrier. 
(2) The total number of annual complaints by category 
of complaint. 
(3) The number of complaints referred in the preceding 
year for enforcement or corrective action by the Department. 
(4) Any recommendations under paragraphs (2)(C) and 
(2)(D) of subsection (c). 
(5) Such other data as the Aviation Consumer Advocate 
considers appropriate. 
(e) SUNSET
ON
REPORTING
REQUIREMENT.—The reporting 
requirement of subsection (d) shall terminate on September 30, 
2023. 
SEC. 425. TICKETS ACT. 
(a) SHORT TITLE.—This section may be cited as the ‘‘Trans-
parency Improvements and Compensation to Keep Every Ticket-
holder Safe Act of 2018’’ or the ‘‘TICKETS Act’’. 
(b) BOARDED PASSENGERS.—Beginning on the date of enactment 
of this Act, a covered air carrier may not deny a revenue passenger 
traveling on a confirmed reservation permission to board, or invol-
untarily remove that passenger from the aircraft, once a revenue 
passenger has— 
(1) checked in for the flight prior to the check-in deadline; 
and 
(2) had their ticket or boarding pass collected or electroni-
cally scanned and accepted by the gate agent. 
(c) LIMITATIONS.—The prohibition pursuant to subsection (b) 
shall not apply when— 
(1) there is a safety, security, or health risk with respect 
to that revenue passenger or there is a safety or security 
issue requiring removal of a revenue passenger; or 
(2) the revenue passenger is engaging in behavior that 
is obscene, disruptive, or otherwise unlawful. 
(d) RULE OF CONSTRUCTION.—Nothing in this section may be 
construed to limit or otherwise affect the responsibility or authority 
of a pilot in command of an aircraft under section 121.533 of