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 med-
ical 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 fol-
lowing bill; which was referred to the Committee on Transportation and 
Infrastructure, and in addition to the Committee on Energy and Com-
merce, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned 
A BILL 
To recognize and clarify the authority of the States to regu-
late the medical aspects of intrastate air ambulance serv-
ices 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Air Ambulance Patient 
Safety, Protection, and Coordination Act’’. 
SEC. 2. CLARIFICATION OF STATE AUTHORITY OVER THE 
MEDICAL 
ASPECTS 
OF 
AIR 
AMBULANCE 
SERVICES. 
(a) IN GENERAL.—Chapter 401 of title 49, United 
States Code, is amended by adding at the end the fol-
lowing: 
‘‘§ 40130. Clarification of State authority over the 
medical aspects of air ambulance services 
‘‘(a) CLARIFICATION OF STATE AUTHORITY.—Pursu-
ant to a State’s authority over the licensure and regulation 
of health care services within its borders, a State may pre-
scribe licensing and other regulatory requirements related 
to the medical aspects of intrastate air ambulance services 
in the same manner that it regulates other health care 
services within its borders and may integrate such services 
into the State’s emergency medical services system, includ-
ing by establishing requirements related to the following: 
‘‘(1) The quality of emergency medical care 
provided to patients by air ambulances, including— 
‘‘(A) the medical qualifications and med-
ical training of medical personnel; 
‘‘(B) medical records and data collection 
and reporting; 
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‘‘(C) outcome and proficiency measures; 
‘‘(D) affiliation with health care institu-
tions for medical oversight, critical care medical 
education, and clinical experience in critical 
care settings; 
‘‘(E) participation in patient safety and 
quality control initiatives, such as peer review, 
utilization review, and error reporting; 
‘‘(F) medical accreditation; 
‘‘(G) licensing of personnel including scope 
of practice and credentialing; and 
‘‘(H) medical oversight. 
‘‘(2) The availability of air ambulance services 
provided to patients with emergency medical condi-
tions, including— 
‘‘(A) service during specified hours and 
days to ensure the availability of life-saving 
medical services as part of the State’s emer-
gency medical services system; and 
‘‘(B) coordination of services, agreements, 
and flight requests for patients with emergency 
medical conditions being transported from the 
scene at which the patient’s injury or accident, 
or other event resulting in the need for medical 
services for the patient, occurred. 
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‘‘(3) Communication between— 
‘‘(A) emergency medical and public safety 
agencies and hospitals; and 
‘‘(B) the flightcrew and air ambulance 
medical personnel to the extent that the com-
munications do not interfere with the safe oper-
ation of the flight. 
‘‘(4) The accessibility of emergency medical 
care provided by air ambulances and the incorpora-
tion and integration of air ambulance services into 
State emergency medical services systems, includ-
ing— 
‘‘(A) access to air ambulance services in 
regions of a State; 
‘‘(B) the provision of services to all per-
sons for whom such services are medically nec-
essary and appropriate regardless of ability to 
pay; 
‘‘(C) the proffer of gifts of monetary value 
to referring entities; 
‘‘(D) medical criteria, based on the pa-
tient’s medical need for transport from the 
scene at which the patient’s injury or accident, 
or other event resulting in the need for medical 
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services for the patient occurred, for deter-
mining the appropriate— 
‘‘(i) mode of transport (ground versus 
air) utilizing evidence-based triage criteria 
to the extent available; 
‘‘(ii) air ambulance to be utilized to 
transport a patient in accordance with its 
capability to meet the patient’s medical 
need; and 
‘‘(iii) medical institution to receive the 
patient. 
‘‘(5) The acceptability of air ambulance services 
to ensure the adequate and appropriate provision of 
medically necessary emergency medical care provided 
by air ambulances to protect critically ill and injured 
patients, including— 
‘‘(A) medical equipment, devices, and sup-
plies to be carried on board or affixed to the air 
ambulance; 
‘‘(B) sanitation and infection control; 
‘‘(C) licensing of the air ambulance agency 
or program; 
‘‘(D) licensing of the ambulance vehicle; 
‘‘(E) truth in advertising requirements; 
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‘‘(F) physical attributes of the air ambu-
lance necessary for the provision of quality 
medical care, including— 
‘‘(i) permanently installed climate con-
trol systems capable of meeting specified 
temperature settings; 
‘‘(ii) a configuration that allows ade-
quate access to the patient, medical equip-
ment, and medical supplies by the medical 
personnel; 
‘‘(iii) the use of materials in the air 
ambulance that are appropriate for proper 
patient care; 
‘‘(iv) sufficient electrical supply to 
support medical equipment without com-
promising the ambulance power; and 
‘‘(v) the ability of the air ambulance 
to transport a patient a certain distance 
without refueling within the State. 
‘‘(6) Physical attributes of the air ambulance 
necessary— 
‘‘(A) for the protection of the ambulance, 
ground, and emergency response personnel; and 
‘‘(B) to ensure that the air ambulance has 
no structural or functional defects that may ad-
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versely affect such personnel, such as by requir-
ing the provision of tailrotor illumination for 
loading patients at night or external search 
lights. 
‘‘(b) APPLICABILITY OF FEDERAL AVIATION SAFETY 
AUTHORITY.—No State health-related regulation estab-
lished pursuant to this section shall supersede or be incon-
sistent with any Federal operating requirement with re-
spect to aviation safety. 
‘‘(c) LIMITATIONS.— 
‘‘(1) IN
GENERAL.—State requirements and 
regulations prescribed pursuant to this section must 
be in accordance with objective, competitive, and 
transparent processes designed to ensure the highest 
quality of emergency medical care and patient safe-
ty, best outcomes, and access to life-saving emer-
gency medical services as part of an integrated 
emergency medical services system. 
‘‘(2) PRICES.—This section shall not be con-
strued to allow State regulation of the prices 
charged by air ambulances for their services. 
‘‘(3) 
PROVIDERS
LICENSED
IN
MULTIPLE 
STATES.—If an air ambulance is licensed to provide 
services in more than one State and the regulations 
established pursuant to this subsection by the States 
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are inconsistent, the provider shall comply with the 
most stringent of such regulations. 
‘‘(4) 
NONDELEGATION
REQUIREMENT.—A 
State may not delegate authority provided under this 
section to a political subdivision of the State. 
‘‘(d) INTERSTATE AGREEMENTS.—In regulating the 
provision of air ambulance services pursuant to this sec-
tion, a State shall, if necessary, establish regulations or 
negotiate mutual aid agreements with adjacent States or 
air ambulances to ensure access to air ambulance services 
across State borders. 
‘‘(e) DEFINITIONS.— 
‘‘(1) AIR
AMBULANCE
SERVICES.—The term 
‘air ambulance services’ means the transport by an 
air ambulance of a patient, in both emergency and 
nonemergency situations, as well as the medical 
services provided to such patient in the course of 
transport by such air ambulance. 
‘‘(2) FEDERAL OPERATING REQUIREMENTS.— 
The term ‘Federal operating requirements’ means 
requirements under part A of subtitle VII of title 
49, United States Code, and Federal aviation regu-
lations set forth in title 14, Code of Federal Regula-
tions. 
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‘‘(3) REFERRING ENTITIES.—The term ‘refer-
ring entity’ means any entity that dispatches or pro-
vides a referral for a provider of air ambulance serv-
ices, such as a medical institution, an agency pro-
viding emergency medical services, or a first re-
sponder.’’. 
(b) CONFORMING AMENDMENT.—The analysis for 
such chapter is amended by adding at the end the fol-
lowing: 
‘‘40130. Clarification of State authority over the medical aspects of air ambu-
lance services.’’. 
Æ 
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