text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Helicopter Medical Services Patient 
  Safety, Protection, and Coordination Act''.
  
  SEC. 2. FINDINGS.
  
      Congress finds the following:
              (1) The Federal Aviation Administration is responsible for 
          regulating civil aviation in the United States.
              (2) Each State is responsible for the regulation of 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 its 
          jurisdiction.
              (3) Helicopter medical services are an essential component 
          of the health care delivery and emergency medical services 
          system in each State and are integral to each State's 
          management of 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 the State's jurisdiction.
              (4) Existing or future regulation of helicopter medical 
          services by the several States is in the public interest.
              (5) Helicopter medical services represent a unique and 
          discrete area of air transportation because those services 
          present issues involving the adequacy and availability of 
          medical services to patients.
              (6) Court rulings and statutory interpretations issued by 
          the Secretary of Transportation have imposed limitations on, 
          impeded, or prevented, the ability of States to effectively 
          regulate helicopter medical services in a manner similar to the 
          regulation of other health care services by the States.
              (7) Those rulings and interpretations have concluded 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 pursuant to the 
          preemption provisions of the Airline Deregulation Act of 1978 
          (Public Law 95-504; 92 Stat. 1705) or through the application 
          of the ``field occupation'' preemption doctrine.
              (8) The Airline Deregulation Act of 1978 did not 
          contemplate helicopter medical services, and the use of the Act 
          to strike down intrastate health-related regulations overseeing 
          the provision of helicopter medical services that would 
          otherwise be permissible with respect to any other segment of 
          the health care industry is not in the public interest.
              (9) At the same time, it is also important to ensure that 
          the Federal Aviation Administration's plenary and exclusive 
          jurisdiction over matters of aviation safety is not infringed 
          by any State. Accordingly, any State health-related regulation 
          of helicopter medical services must be harmonized and shall not 
          be inconsistent with Federal regulation of aviation safety 
          because the safe operation of the helicopter medical services 
          flight is of paramount importance.
              (10) 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 
          government's plenary power to regulate aviation safety.
  
  SEC. 3. CLARIFICATION OF STATE AUTHORITY OVER HELICOPTER MEDICAL 
                SERVICES.
  
      (a) In General.--Chapter 401 of title 49, United States Code, is 
  amended by adding at the end the following:
  ``Sec. 40130. Clarification of State authority over helicopter medical 
                services
      ``(a) Clarification of State Authority.--Nothing in this subtitle 
  shall prohibit a State from--
              ``(1) requiring medical licenses for the provision of 
          helicopter medical services between locations within the State; 
          or
              ``(2) prescribing regulations relating to the provision of 
          such services if such regulations are prescribed pursuant to 
          subsection (c), (d), or (e).
      ``(b) Applicability of Federal Aviation Safety Authority.--No State 
  health-related regulation established pursuant to this section shall 
  supersede or be inconsistent with any Federal operating requirement 
  with respect to aviation safety.
      ``(c) State Authority Over Medical Services.--A State may prescribe 
  regulations relating to the provision of helicopter medical services 
  with respect to the following:
              ``(1) The medical qualifications and medical training of 
          helicopter medical personnel, except that a State may not 
          impose any requirement with respect to a pilot.
              ``(2) The obligation of providers of helicopter medical 
          services to comply with the health planning, patient safety, 
          and medical service requirements of the State, including--
                      ``(A) coordination of the interrelationship, 
                  interaction, and agreements among providers of 
                  helicopter medical services, providers of other 
                  emergency medical services, providers of other medical 
                  transport services, referring entities, and medical 
                  institutions that receive patients transported by 
                  providers of helicopter medical services with respect 
                  to the transport of patients;
                      ``(B) demonstration of adequate capacity to provide 
                  helicopter medical services;
                      ``(C) demonstration of the need for new or expanded 
                  helicopter medical services;
                      ``(D) determinations with respect to the number and 
                  base location of helicopters used in the provision of 
                  helicopter medical services within the State or region 
                  of the State or the regulation of competition for 
                  specific markets within the State;
                      ``(E) affiliation with health care institutions;
                      ``(F) sanitation and infection control protocols;
                      ``(G) medical records requirements;
                      ``(H) quality of medical care requirements, 
                  including participation in patient safety and medical 
                  quality control efforts, such as peer review processes, 
                  utilization review, and error reporting systems; and
                      ``(I) the proffer of gifts of monetary value (other 
                  than training or educational programs) to referring 
                  entities (or personnel employed by such entities) 
                  within the State.
      ``(d) State Authority Over Medical Services Subject to 
  Harmonization Requirement.--A State may prescribe regulations relating 
  to the provision of helicopter medical services with respect to the 
  following, if such regulations are harmonized with, and do not infringe 
  upon, any applicable Federal operating requirements:
              ``(1) The establishment of appropriate medical criteria for 
          determining the appropriate medical institution to receive a 
          patient 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.
              ``(2) The specification of service requirements with 
          respect to geographic areas within the State or during 
          specified hours and days.
              ``(3) The coordination of flight requests for emergency 
          helicopter medical services.
              ``(4) The compliance with accreditation requirements 
          regarding medical services, except where such requirements 
          infringe upon relevant Federal operating requirements.
              ``(5) The provision of emergency helicopter medical 
          services to all persons for whom such services are medically 
          necessary and appropriate.
      ``(e) State Authority Over Medical Services Subject to Consistency 
  Requirement.--
              ``(1) In general.--Subject to paragraph (2), a State may 
          prescribe regulations relating to the provision of helicopter 
          medical services with respect to the following, if such 
          regulations are consistent with, and do not infringe upon, any 
          applicable Federal operating requirements:
                      ``(A) The necessary medical equipment and supplies 
                  to be carried on board or affixed to the helicopter.
                      ``(B) The physical attributes of the helicopter--
                              ``(i) necessary for the provision of 
                          quality medical care, including--
                                      ``(I) permanently installed climate 
                                  control systems capable of meeting 
                                  specified temperature settings;
                                      ``(II) a configuration that allows 
                                  adequate access to the patient, medical 
                                  equipment, and medical supplies by the 
                                  helicopter medical personnel;
                                      ``(III) use of materials in the 
                                  helicopter that are appropriate for 
                                  proper patient care;
                                      ``(IV) sufficient electrical supply 
                                  to support medical equipment without 
                                  compromising helicopter power; and
                                      ``(V) the ability of the helicopter 
                                  to transport a patient a certain 
                                  distance without refueling within the 
                                  State; and
                              ``(ii) necessary--
                                      ``(I) for the protection of 
                                  helicopter personnel, ground medical 
                                  personnel, and emergency response 
                                  personnel; and
                                      ``(II) to ensure that the 
                                  helicopter has no structural or 
                                  functional defects that may adversely 
                                  affect such personnel, such as by 
                                  requiring tailroter illumination for 
                                  loading patients at night or external 
                                  search lights.
                      ``(C) Communication capabilities enabling--
                              ``(i) the helicopter medical personnel to 
                          communicate with emergency medical services and 
                          public safety personnel and personnel at 
                          medical institutions that receive patients 
                          transported by providers of helicopter medical 
                          services; and
                              ``(ii) the flightcrew to communicate with 
                          the helicopter medical personnel, to the extent 
                          that the communications do not interfere with 
                          the safe operation of the flight.
              ``(2) Limitations.--
                      ``(A) Providers licensed in multiple states.--If a 
                  provider of helicopter medical services is licensed to 
                  provide such services in more than one State and the 
                  regulations established pursuant to this subsection by 
                  the States in which the provider is licensed are 
                  inconsistent, the provider shall comply with the most 
                  stringent of such regulations.
                      ``(B) Nondelegation requirement.--A State may not 
                  delegate authority provided under this subsection to a 
                  political subdivision of the State.
      ``(f) Interstate Agreements.--In regulating the provision of 
  helicopter medical services pursuant to this section, a State shall, if 
  necessary, establish regulations or negotiate mutual aid agreements 
  with adjacent States or providers of helicopter medical services in 
  adjacent States to ensure access to helicopter medical services across 
  State borders.
      ``(g) Definitions.--In this section:
              ``(1) Helicopter medical services.--The term `helicopter 
          medical services' means the helicopter 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 requirements under part A of 
          subtitle VII of title 49, United States Code, and Federal 
          aviation regulations set forth in title 14, Code of Federal 
          Regulations.
              ``(3) Referring entities.--The term `referring entity' 
          means any entity that dispatches or provides a referral for a 
          provider of helicopter medical services, such as a medical 
          institution, an agency providing emergency medical services, or 
          a first responder.''.
      (b) Conforming Amendment.--The table of sections at the beginning 
  of chapter 401 of title 49, United States Code, is amended by adding at 
  the end the following:
  
  ``40130. Clarification of State authority over intrastate helicopter 
                              medical services.''.
target: Helicopter Medical Services Patient Safety, Protection, and Coordination Act - Authorizes states to regulate helicopter medical services with respect to: (1) the medical qualifications and training of helicopter medical personnel; and (2) the obligation of providers of helicopter medical services to comply with a state's health planning, patient safety, and medical service requirements. Prohibits states from imposing requirements on pilots.
  
  Authorizes states to regulate the following aspects of helicopter medical services to the extent such regulations are harmonized with applicable federal operating requirements: (1) establishment of criteria for determination of the appropriate medical institution to receive a transported patient; (2) specification of service requirements with respect to geographic areas within a state or during specified hours and days; (3) coordination of flight requests for emergency helicopter medical services; (4) compliance with medical services accreditation requirements, except where they infringe upon relevant federal operating requirements; and (5) provision of emergency helicopter medical services to all persons where needed.
  
  Authorizes a state to regulate certain aspects of helicopter medical services to the extent that such regulations are consistent with, and do not infringe upon, applicable federal operating requirements.
  
  Specifies among the aspects of helicopter medical services which states may regulate: (1) the necessary medical equipment and supplies to be carried on board or affixed to the helicopter; (2) the physical attributes of the helicopter necessary for the provision of quality medical care and for the protection of helicopter, ground medical, and emergency response personnel; and (3) specified communication capabilities among helicopter medical personnel and emergency medical services and public safety personnel, and between the flight crew and helicopter medical personnel. Requires a provider of helicopter medical services that is licensed in more than one state where state helicopter medical services regulations are inconsistent to comply with the most stringent regulation.
  
  Requires a state, if necessary, to establish regulations or negotiate mutual aid agreements with adjacent states, or providers of helicopter medical services in such states, to ensure access to such services across state borders.
feat_title: A bill to recognize and clarify the authority of the States to regulate intrastate helicopter medical services, and for other purposes.