I 
115TH CONGRESS 
1ST SESSION H. R. 3780 
To amend title XVIII of the Social Security Act to provide under the Medicare 
program for conditions of participation, reporting requirements, and a 
quality program with respect to air ambulance services. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 14, 2017 
Mr. HUDSON (for himself, Mr. KENNEDY, Ms. JENKINS of Kansas, and Mr. 
KIND) introduced the following bill; which was referred to the Committee 
on Energy and Commerce, and in addition to the Committee on Ways 
and Means, for a period to be subsequently determined by the Speaker, 
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
under the Medicare program for conditions of participa-
tion, reporting requirements, and a quality program with 
respect to air ambulance services. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Air Ambulance Quality 
and Accountability Act’’. 
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SEC. 2. FINDINGS. 
Congress finds as follows: 
(1) Patient access to high quality and essential 
air ambulance services can mean the difference be-
tween life and death and quality of survival for pa-
tients. 
(2) Medicare should assure beneficiaries of high 
quality air ambulance services and patient safety. 
(3) Medicare has no requirements related to 
quality measurement and reporting, adherence to 
relevant standards as a condition of participating in 
Medicare, and robust cost reporting. 
(4) Medicare currently reimburses all suppliers 
and providers of air ambulance services the same, 
regardless of clinical capability or investment in 
aviation safety that exceeds requirements of the 
Federal Aviation Administration. 
(5) A subset of patients requiring air transport 
are so critically ill or injured as to require an ad-
vanced level of clinical capability to address unstable 
and life-threatening medical conditions that may de-
velop or deteriorate during transport. The costs of 
providing care to such patients should be reported to 
enable the Congress to assess the sufficiency and ap-
propriateness of reimbursement for these most vul-
nerable patients. 
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(6) There remain many geographic areas of the 
nation with limited access to air ambulance services 
due to low volume of patients in geographically iso-
lated and very rural areas. 
(7) Medicare and Medicaid payment should be 
adequate to protect and promote access to air ambu-
lance services that are capable of meeting the clin-
ical needs of the most critically ill and injured pa-
tients, allow necessary investments in transport safe-
ty, and enable transport to the appropriate medical 
center to receive them. 
(8) An evaluation of Medicare payment policy is 
warranted to assess and secure recommendations 
about payment adequacy for air ambulance providers 
and suppliers and the realistic costs of providing this 
life-saving transport services. 
(9) Mandatory cost reporting is necessary for 
air ambulance services providers receiving Medicare 
reimbursement to ensure fair and adequate reim-
bursement and allow appropriate access. 
(10) Such reporting should also capture essen-
tial data with regard to access, cost, utilization, 
quality and variation of such services to enable more 
specifically narrowly tailoring payments commensu-
rate with higher costs actually incurred such as 
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those treating the most critically ill and injured, in-
vesting in higher cost aviation safety and airframes, 
and serving patients in the most geographically iso-
lated areas. 
SEC. 3. STANDARDS FOR AIR AMBULANCE PROVIDERS AND 
SUPPLIERS. 
(a) MINIMUM STANDARDS.—Section 1834(l) of the 
Social Security Act (42 U.S.C. 1395m(l)) is amended by 
adding at the end the following new paragraph: 
‘‘(17) MINIMUM
STANDARDS
FOR
AIR
AMBU-
LANCE PROVIDERS AND SUPPLIERS.— 
‘‘(A) IN GENERAL.—Not later than 2 years 
after the date of the enactment of this para-
graph, the Secretary shall, in consultation with 
relevant stakeholders, establish minimum stand-
ards which air ambulance suppliers and pro-
viders would be required to satisfy as a condi-
tion of participation under this title. 
‘‘(B) AIR
AMBULANCE
MINIMUM
STAND-
ARDS.—In establishing the minimum standards 
under subparagraph (A), the Secretary shall in-
clude at least minimum standards with respect 
to the following: 
‘‘(i) Scope of practice, training and 
clinical capability of medical personnel rel-
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evant to medical condition of patients 
transported. 
‘‘(ii) Medical equipment (such as pa-
tient 
monitoring, 
respiratory 
and 
hemodynamic and other relevant patient 
support equipment), devices, technology 
and formularies. 
‘‘(iii) Vehicle attributes to support 
needed care, including configuration and 
conditions of medical environment, elec-
trical supply in air ambulance and other 
related equipment. 
‘‘(iv) Documentation standards, such 
as patient care records, timeline of care 
and transport, history of present illness 
and assessments, and documentation spe-
cific to diagnostic and therapeutic proce-
dures. 
‘‘(v) Medical direction and physician 
medical oversight, such as credentials of 
such physicians. 
‘‘(vi) Reporting of always events, such 
as care coordination and transition, pain 
management, preventing ventilator ac-
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quired pneumonia or invasive line or 
wound infections. 
‘‘(vii) Reporting of never events, such 
as loss of oxygen, delivery of a baby during 
transport, patient death or disability due 
to vehicle failure or crash, transport to un-
intended destination, dropping a patient or 
allowing a fall during movement of patient, 
failure to communicate time of arrival, 
hypoglycemia, and medication errors. 
‘‘(viii) Patient safety and infection 
control. 
‘‘(ix) Physician directed clinical qual-
ity management and clinical performance 
improvement programs including quality 
assurance, utilization review, outcomes, 
proficiency measures and patient safety. 
‘‘(x) Standards relevant to particular 
populations, such as those on balloon 
pumps or ECMO. 
‘‘(C) DEEMED
STATUS.—Air ambulance 
providers and suppliers that are accredited by 
an accreditation organization approved by the 
Secretary as having standards that meet or ex-
ceed the Secretary’s standards for such pro-
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viders shall be deemed to be in compliance with 
the minimum requirements required pursuant 
to this paragraph.’’. 
SEC. 4. AIR AMBULANCE COST REPORTING PROGRAM. 
Section 1834(l) of the Social Security Act (42 U.S.C. 
1395m(l)), as amended by section 3, is further amended 
by adding at the end the following new paragraph: 
‘‘(18) AIR AMBULANCE COST REPORTING PRO-
GRAM.— 
‘‘(A) IN GENERAL.—For the first year be-
ginning at least 12 months after the date of the 
enactment of this paragraph and each subse-
quent year, an air ambulance provider or sup-
plier of air ambulance services shall submit to 
the Secretary (in a form and manner and at 
such time as specified by the Secretary) data 
described in subparagraph (B) for the reporting 
period (as specified by the Secretary) for such 
year. 
‘‘(B) COST DATA.—For purposes of report-
ing data under this for air ambulance services 
furnished with respect to a year, the data de-
scribed in this subparagraph are cost data spec-
ified by the Secretary relating to the following: 
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‘‘(i) Geographic location factors, in-
cluding mileage and number of providers 
in the service area. 
‘‘(ii) Capital and operational costs, 
such as the type of aircraft, including fixed 
wing aircraft, rotary wing aircraft—single 
or twin engine, instrumented flight or vis-
ual flight. 
‘‘(iii) Maintenance of aircraft, includ-
ing avionics, communications equipment, 
fuel, and general repairs. 
‘‘(iv) Maintenance of equipment, in-
cluding specialty clinical equipment. 
‘‘(v) Medical supplies. 
‘‘(vi) Employee expenses, including 
salaries and insurance (life, health, and li-
ability). 
‘‘(vii) Building expenses, including 
rent and maintenance. 
‘‘(viii) Any other costs as specified by 
the Secretary, in consultation with the Sec-
retary of Transportation, as needed to be 
included under this subparagraph for pur-
poses of informing the report and evalua-
tion under section 6 of the Air Ambulance 
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Quality and Accountability Act or for pur-
poses of enabling Congress to make appro-
priate determinations about payment under 
this section to air ambulance providers and 
suppliers. 
The Secretary, in consultation with providers 
and suppliers of air ambulance services, shall 
periodically update, as determined necessary by 
the Secretary, the cost data specified pursuant 
to this subparagraph. 
‘‘(C) SUSPENSION OF PAYMENT FOR FAIL-
URE TO REPORT.— 
‘‘(i) IN
GENERAL.—With respect to 
air ambulance services furnished by a sup-
plier or provider of air ambulance services 
during the second year beginning at least 
12 months after the date of the enactment 
of this paragraph or any subsequent year, 
in the case that the supplier or provider 
does not submit data to the Secretary in 
accordance with subparagraph (A) for the 
reporting period applicable to such year 
(which shall be during the previous year), 
the Secretary shall suspend payments 
under the fee schedule under this sub-
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section for air ambulance services fur-
nished by such supplier or provider during 
such year until such supplier or provider 
submits such data in accordance with such 
subparagraph. 
‘‘(ii) TREATMENT OF NEW MEDICARE 
SUPPLIERS AND PROVIDERS OF AIR AMBU-
LANCE SERVICES.—In the case of a sup-
plier or provider of air ambulance services 
that first becomes a Medicare enrolled sup-
plier or provider of air ambulance services 
during the reporting period applicable to a 
year with respect to which clause (i) ap-
plies (and had not previously submitted 
claims under this title such as a person or 
entity or under a different billing number 
or tax identifier), such supplier or provider 
shall not be subject to clause (i) until the 
subsequent year and with respect to data 
required to be submitted for the reporting 
period applicable to such subsequent 
year.’’. 
SEC. 5. AIR AMBULANCE QUALITY REPORTING PROGRAM. 
Section 1834(l) of the Social Security Act (42 U.S.C. 
1395m(l)), as amended by sections 3 and 4, is further 
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amended by adding at the end the following new para-
graph: 
‘‘(19) AIR
AMBULANCE
QUALITY
REPORTING 
PROGRAM.— 
‘‘(A) PAYMENT
BASED
ON
PERFORM-
ANCE.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall establish an air ambulance quality re-
porting and performance program under 
which— 
‘‘(I) with respect to air ambu-
lance services furnished by a supplier 
or provider of air ambulance services 
during the first consequence year, sec-
ond consequence year, or third con-
sequence year, in the case that the 
supplier or provider does not submit a 
report, with respect to the perform-
ance period for such year, in accord-
ance with subparagraph (C), after de-
termining the percentage increase 
under paragraph (3)(B), and after ap-
plication of paragraphs (3)(C) and 
(18), the Secretary shall reduce such 
percentage 
increase 
for 
payments 
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plier or provider of air ambulance services 
that first becomes a Medicare enrolled sup-
plier or provider of air ambulance services 
during the performance period for a con-
sequence year (and had not previously sub-
mitted claims under this title such as a 
person or entity or under a different billing 
number or tax identifier), the adjustment 
under clause (i) shall not apply to such 
supplier or provider until the subsequent 
consequence year and performance period 
for such subsequent consequence year. 
‘‘(B) DETERMINING PERFORMANCE.— 
‘‘(i) IN GENERAL.—Under the air am-
bulance quality reporting and performance 
program, the performance of a provider or 
supplier of air ambulance services with re-
spect to a performance period with respect 
to a consequence year after the third con-
sequence year shall be determined as speci-
fied by the Secretary based on data re-
quired under subparagraph (C) to be sub-
mitted (in a form and manner and at such 
time as specified by the Secretary) by the 
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‘‘(II) in the case of a con-
sequence year before the fourth con-
sequence year— 
‘‘(aa) at least 2 of the meas-
ures described in subparagraph 
(D)(ii)(I); and 
‘‘(bb) at least 2 of the meas-
ures established under subpara-
graph (D)(iii)(I); and 
‘‘(III) in the case of a con-
sequence year beginning with the 
fourth consequence year— 
‘‘(aa) at least 4 of the meas-
ures described in subparagraph 
(D)(ii)(II); and 
‘‘(bb) at least 4 of the meas-
ures established under subpara-
graph (D)(iii)(II). 
‘‘(ii) AVAILABILITY
OF
DATA.—The 
Secretary shall establish procedures for 
making data submitted under clause (i) 
available to the public. Such procedures 
shall ensure that— 
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‘‘(I) data submitted under clause 
(i) for the first consequence year shall 
not be made public; and 
‘‘(II) an air ambulance provider 
or supplier has the opportunity to re-
view the data that is to be made pub-
lic with respect to the air ambulance 
provider or supplier prior to such data 
being made public. 
‘‘(D) 
MEASURES.—In 
establishing 
the 
quality program under subparagraph (A), the 
following shall apply: 
‘‘(i) OVER-TRIAGE.—The Secretary 
shall provide for the application of a meas-
ure with respect to over-triage in mode of 
transportation. 
‘‘(ii) PATIENT SAFETY MEASURES.— 
The Secretary shall, in consultation with 
providers and suppliers of air ambulance 
services, establish— 
‘‘(I) with respect to a perform-
ance period with respect to a con-
sequence year before the fourth con-
sequence year, at least 3 patient safe-
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ty measures for providers and sup-
pliers of air ambulance services; and 
‘‘(II) with respect to a perform-
ance period with respect to a con-
sequence year beginning with the 
fourth consequence year, at least 6 
patient safety measures for providers 
and suppliers of air ambulance serv-
ices. 
‘‘(iii) 
CLINICAL
QUALITY
MEAS-
URES.—The Secretary shall, in consulta-
tion with providers and suppliers of air 
ambulance services, establish— 
‘‘(I) with respect to a perform-
ance period with respect to a con-
sequence year before the fourth con-
sequence year, at least 3 clinical qual-
ity measures for providers and sup-
pliers of air ambulance services; and 
‘‘(II) with respect to a perform-
ance period with respect to a con-
sequence year beginning with the 
fourth consequence year, at least 6 
clinical quality measures for providers 
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and suppliers of air ambulance serv-
ices. 
‘‘(iv) UPDATES.—The Secretary, in 
consultation with providers and suppliers 
of air ambulance services, shall periodically 
update, as determined necessary by the 
Secretary, the measures to be applied pur-
suant to this subparagraph. 
‘‘(E) DEFINITIONS.—For purposes of this 
paragraph: 
‘‘(i) The term ‘consequence year’ 
means a year beginning with the 5th year 
starting at least 12 months after the date 
of the enactment of this paragraph. The 
terms ‘first consequence year’, second con-
sequence year, and third consequence year 
mean such 5th year starting at least 12 
months after such date of enactment, the 
6th year starting at least 12 months after 
such date of enactment, and the 7th year 
starting at least 12 months after such date 
of enactment, respectively. 
‘‘(ii) The term ‘performance period’ 
means, with respect to a consequence year, 
such period as specified by the Secretary.’’. 
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SEC. 6. MEDPAC STUDY ON ACCESS, QUALITY, COSTS, AND 
REIMBURSEMENT. 
(a) EVALUATION.—Not later than three years after 
December 31 of the first year to which paragraph (18) 
of section 1834(l) of the Social Security Act, as added by 
section 4, applies, the Medicare Payment Advisory Com-
mission shall submit to Congress a report containing an 
evaluation of the costs of air providers and suppliers. Such 
evaluation shall— 
(1) be derived from the cost and other data 
submitted under such paragraph (18) of such sec-
tion 1834(l); and 
(2) differentiate as appropriate to recognize 
variation or higher costs related to— 
(A) aviation instrument flight control; 
(B) provision of care to critically ill or in-
jured patients; 
(C) the provision of services in geographi-
cally isolated areas; and 
(D) the provision of care to uninsured indi-
viduals. 
(b) RECOMMENDATIONS.—As part of the report sub-
mitted under subsection (a), the Medicare Payment Advi-
sory Commission shall provide recommendations on 
whether changes should be made with regard to reim-
bursement of air ambulance providers and suppliers under 
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