(5) Court rulings and statutory interpretations 
issued by the Department of Transportation have 
imposed limitations on the authority of States to 
regulate helicopter medical services in a manner 
similar to the regulation of other health care services 
by the States. 
(6) These rulings and interpretations have con-
cluded that certain State actions related to public 
health planning and protection, patient safety and 
protection, emergency medical services, the quality 
and coordination of medical care, and the practice of 
medicine and related aspects of helicopter medical 
services are preempted by Federal law, either pursu-
ant to the preemption provisions of the Airline De-
regulation Act of 1978 or through the application of 
the ‘‘field occupation’’ preemption doctrine. 
(7) The Airline Deregulation Act of 1978 did 
not contemplate helicopter medical services, and the 
use of the Act to strike down intrastate health-re-
lated regulations overseeing helicopter medical serv-
ices that would otherwise be permissible with respect 
to any other segment of the health care industry is 
not in the public interest. 
(8) At the same time, it is also important to en-
sure that the Federal Aviation Administration’s ple-
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nary and exclusive jurisdiction over matters of avia-
tion safety is not infringed by any State and that 
State health-related regulation of helicopter medical 
services is harmonized with Federal regulation of 
aviation safety. 
(9) Accordingly, there is a need for clarification 
of existing Federal law so that States may regulate 
helicopter medical services with respect to public 
health planning and protection, patient safety and 
protection, emergency medical services, the quality 
and coordination of medical care, and the practice of 
medicine without infringing on the Federal govern-
ment’s plenary power to regulate aviation safety. 
SEC. 3. CLARIFICATION OF STATE AUTHORITY OVER 
INTRASTATE HELICOPTER MEDICAL SERV-
ICES. 
(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 intra-
state helicopter medical services 
‘‘(a) CLARIFICATION OF STATE AUTHORITY.—Noth-
ing in this subtitle shall prohibit a State from regulating 
helicopter medical services provided between locations 
within such State (or helicopter medical services provided 
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between locations in more than one State if undertaken 
pursuant to an agreement between or among such States) 
in the manner described in subsection (b), (c), or (d). 
‘‘(b) STATE AUTHORITY OVER MEDICAL SERV-
ICES.—A State may regulate helicopter medical services 
with respect to the following: 
‘‘(1) The medical qualifications and medical 
training of helicopter medical personnel, except that 
a State shall not impose new or additional require-
ments on a pilot. 
‘‘(2) The obligation of providers of helicopter 
medical services to comply with the health planning, 
patient safety, and medical service requirements of 
a State, including— 
‘‘(A) coordination between emergency med-
ical services providers, receiving institutions, 
and other medical transport service providers 
regarding the transport of a patient; 
‘‘(B) demonstration of adequate capacity 
to provide helicopter medical services; 
‘‘(C) demonstration of the need for new or 
expanded helicopter medical services; 
‘‘(D) limitations on the number of heli-
copters providing helicopter medical services 
within the State or region of the State; 
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‘‘(E) affiliation with health care institu-
tions; 
‘‘(F) sanitation and infection control proto-
cols; 
‘‘(G) medical records requirements; 
‘‘(H) quality requirements, including par-
ticipation in patient safety and medical quality 
control efforts, such as peer review processes, 
utilization review, and error reporting systems; 
and 
‘‘(I) the provision of emergency helicopter 
medical services to all persons for whom such 
services are medically necessary and appro-
priate. 
‘‘(c) STATE AUTHORITY OVER MEDICAL SERVICES 
SUBJECT TO HARMONIZATION REQUIREMENT.—To the 
extent that any State regulations are harmonized with any 
relevant Federal operating requirements, a State may reg-
ulate helicopter medical services with respect to the fol-
lowing: 
‘‘(1) The designation of destinations for emer-
gency patient transport. 
‘‘(2) The specification of service requirements 
with respect to geographic areas within a State or 
during specified hours and days. 
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‘‘(3) The coordination of flight requests for 
emergency helicopter medical services. 
‘‘(4) Compliance with accreditation require-
ments. 
‘‘(d) STATE AUTHORITY OVER MEDICAL SERVICES 
SUBJECT TO CONSISTENCY REQUIREMENT.—To the ex-
tent that any State regulations are consistent with any 
relevant Federal operating requirements (such as air-
worthiness and the proper storage and installation of med-
ical equipment) applicable to a helicopter that is otherwise 
capable of meeting such State regulations, a State may 
regulate helicopter medical services with respect to the fol-
lowing: 
‘‘(1) The necessary medical equipment to be 
carried on board or affixed to the helicopter. 
‘‘(2) The physical attributes of the helicopter— 
‘‘(A) necessary for the provision of quality 
medical care, including— 
‘‘(i) climate control; 
‘‘(ii) a configuration that allows ade-
quate access to the patient, medical equip-
ment, and medical supplies by the heli-
copter medical personnel; 
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‘‘(iii) use of materials in the helicopter 
that are appropriate for proper patient 
care; and 
‘‘(iv) sufficient electrical supply to 
support medical equipment without com-
promising helicopter power; and 
‘‘(B) necessary for the protection of heli-
copter and ground medical personnel. 
‘‘(3) Communication capabilities enabling— 
‘‘(A) the helicopter personnel to commu-
nicate with emergency medical services and 
public safety personnel and personnel at receiv-
ing institutions; and 
‘‘(B) the flightcrew to communicate with 
the helicopter medical personnel. 
‘‘(e) DEFINITIONS.—In this section, the following 
definitions apply: 
‘‘(1) HELICOPTER
MEDICAL
SERVICES.—The 
term ‘helicopter medical services’ means the heli-
copter transport 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 helicopter. 
‘‘(2) FEDERAL OPERATING REQUIREMENTS.— 
The term ‘Federal operating requirements’ means 
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