S.Amdt. 3275

SA 3275. Ms. SNOWE submitted an amendment intended to be proposed to
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr.
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal
Revenue Code of 1986 to modify the first-time homebuyers credit in the
case of members of the Armed Forces and certain other Federal
employees, and for other purposes; which was ordered to lie on the
table; as follows:

On page 816, after line 20, insert the following:

SEC. 3115. ACCREDITATION REQUIREMENT FOR ROTARY WING AIR
AMBULANCE SERVICES.

Section 1834 of the Social Security Act (42 U.S.C. 1395m),
as amended by this Act, is amended by adding at the end the
following new subsection:
``(p) Establishment of Rotary Wing Air Ambulance
Accreditation Process.--
``(1) In general.--
``(A) Establishment of process.--The Secretary, in
consultation with the Secretary of Transportation (acting
through the Administrator of the Federal Aviation
Administration), shall establish a process for the
accreditation of suppliers and providers of rotary wing air
ambulance services reimbursed under the fee schedule
established under subsection (l).
``(B) Requirement.--On or after January 1, 2012, payment
may only be made to a supplier or provider of rotary wing air
ambulance services (whether provided directly or under
arrangement with a provider under this part) under the fee
schedule established under subsection (l) if such supplier or
provider is accredited by an organization designated by the
Secretary pursuant to the process described in paragraph (2).
``(2) Accreditation organizations.--
``(A) Designation.--Not later than June 30, 2011, the
Secretary shall designate organizations to accredit suppliers
and providers of rotary wing air ambulance services under the
process established under paragraph (1).
``(B) Factors for designation.--The Secretary shall
consider the following factors in designating accreditation
organizations under subparagraph (A):
``(i) The ability of the organization to provide timely
reviews of applications.
``(ii) Whether the organization uses random site visits,
site audits, or other strategies for ensuring adherence to
the criteria developed under paragraphs (3), (4), and (5).
``(iii) The ability of the organization to take into
account the capacities of and special circumstances
applicable to suppliers and providers of rural air ambulance
services (as defined in subsection (l)(14)(C)).
``(iv) The ability of the organization to take into account
the capacities of and special circumstances applicable to
suppliers and providers of air ambulance services that are
owned and operated by units of State or local government,
including those that utilize a single aircraft for both air
ambulance services and public safety purposes.
``(v) Whether the organization has established reasonable
fees to be charged to suppliers and providers applying for
accreditation.
``(vi) With respect to application of the criteria
developed under paragraphs (3), (4), and (5), whether the
organization has applicable experience in the accreditation
of suppliers and providers.
``(vii) Whether the organization has developed an
accreditation program that is adequate and appropriate to the
goal of ensuring high caliber rotary wing air ambulance
services.
``(viii) Such additional factors as are specified by the
Secretary (acting through the Administrator of the Centers
for Medicare & Medicaid Services) with respect to quality,
medical services, and emergency medical services integration
considerations under paragraph (3)(A)(i).
``(ix) Such additional aviation safety-related factors as
are developed by the Administrator of the Federal Aviation
Administration under paragraph (4)(A).
``(x) The ability of the organization to effectively
enforce the criteria developed under paragraphs (3), (4), and
(5).
``(xi) Such other factors as the Secretary determines
appropriate.
``(C) Review and modification of list of accreditation
organizations.--The Secretary, in consultation with the
Secretary of Transportation (acting through the Administrator
of the Federal Aviation Administration) shall review on a
regular basis the list of organizations designated under
subparagraph (A) with reference to the factors described in
subparagraph (B) and, as a result of such review, may modify
the list of organizations so designated by adding or removing
organizations from such list.
``(3) Development of quality, medical services, and ems
integration-related designation factors and accreditation
criteria.--
``(A) Development of designation factors and accreditation
criteria by administrator of cms.--Not later than January 1,
2011, subject to subparagraphs (B) and (C), the Secretary
(acting through the Administrator of the Centers for Medicare
& Medicaid Services) shall--
``(i) develop and transmit to the Secretary the additional
quality, medical services, and integration with State
emergency medical services systems related factors considered
under paragraph (2)(B)(viii) in designating accreditation
organizations under paragraph (2)(A); and
``(ii) develop and provide to the Secretary high-caliber
quality, medical services, and emergency medical services
integration criteria that accreditation organizations
designated under paragraph (2)(A) shall utilize in the
accreditation process established under paragraph (1).
``(B) Consultation with federal aviation administration.--
The Secretary (acting through the Administrator of the
Centers for Medicare & Medicaid Services) shall consult with
the Administrator of the Federal Aviation Administration in
the development of the factors and criteria under clauses (i)
and (ii), respectively, of subparagraph (A).
``(C) Scope of quality, medical services, and ems
integration-related criteria.--
``(i) Considerations.--In developing the criteria under
subparagraph (A)(ii), the Secretary (acting through the
Administrator of the Centers for Medicare & Medicaid
Services) shall consider National Transportation Safety Board
Recommendations A-09-102 through A-09-103 and A-09-106
through A-09-107.
``(ii) Criteria.--Such criteria shall address--

``(I) the presence and qualifications of medical personnel
on board the air ambulance;
``(II) real-time coordination between suppliers and
providers and 911 systems and integration with State
emergency medical systems;
``(III) medical oversight of paramedics, flight nurses, or
other medical personnel on board air ambulances;
``(IV) quality assurance;
``(V) design of the air ambulance medical bay for the
provision of patient care;
``(VI) minimum medically related service requirements;
``(VII) medical equipment and supplies on board the air
ambulance;
``(VIII) the need to obtain licensure of the air ambulance
by the State within which it is based, consistent with
paragraph (8)(C); and
``(IX) such other matters as the Secretary (acting through
the Administrator of the Centers for Medicare & Medicaid
Services determines appropriate.

``(4) Development of aviation safety-related designation
factors and accreditation criteria by administrator of the
faa.--
``(A) Development of designation factors and accreditation
criteria.--Not later than January 1, 2011, subject to
subparagraphs (B) and (C), the Administrator of the Federal
Aviation Administration shall--
``(i) develop and transmit to the Secretary the additional
aviation safety-related factors to be used under paragraph
(2)(B)(ix) in designating accreditation organizations under
paragraph (2)(A); and
``(ii) develop and provide to the Secretary aviation
safety-related criteria that accreditation organizations
designated under paragraph (2)(A) shall utilize in the
accreditation process established under paragraph (1).
``(B) Sole authority of faa over development of aviation
safety-related designation factors and accreditation
criteria.--The Administrator of the Federal Aviation
Administration shall have sole authority over the development
of designation factors and accreditation criteria under
subparagraph (A).
``(C) Scope of aviation safety-related criteria.--
``(i) In general.--The criteria developed by the
Administrator of the Federal Aviation Administration under
subparagraph (A) shall comprise minimum safety requirements
for suppliers and providers of rotary wing air ambulance
services to address aviation safety considerations particular
to the transportation of patients between health care
facilities and from emergency response locations for purposes
of medical care and treatment that augment the operating
standards under part 135 of title 14, Code of Federal
Regulations and other statutory and regulatory requirements
pertaining to aviation safety of helicopter aircraft used for
emergency medical service.
``(ii) Criteria.--Such criteria shall consist of--

``(I) those criteria that the Administrator of the Federal
Aviation Administration adopts based upon consideration of
any National Transportation Safety Board Recommendations
regarding the use of helicopter aircraft for emergency
medical service that are not otherwise required by statute or
regulation; and
``(II) such other matters as the Administrator of the
Federal Aviation Administration determines appropriate.

[[Page S13468]]

``(5) Requirements for criteria development process.--
``(A) Consideration of impacts on patient and rural access
and government owned and operated service providers;
requirement for stakeholder participation.--In developing
accreditation criteria under paragraphs (3) and (4), the
Secretary (acting through the Administrator of the Centers
for Medicare & Medicaid Services) and the Administrator of
the Federal Aviation Administration, respectively, shall--
``(i) ensure that such criteria avoid adversely impacting
beneficiaries under this title and other patient access to
medically necessary and reasonable rotary wing air ambulance
services, particularly in rural areas;
``(ii) expressly consider--

``(I) the particular needs and circumstances of suppliers
and providers of rural air ambulance services (as defined in
subsection (l)(14)(C);
``(II) the particular needs and circumstances of those
suppliers and providers of air ambulance services that are
owned and operated by units of State or local government
(including those that utilize a single aircraft for both air
ambulance services and public safety purposes);
``(III) the extent to which any such criteria is
economically feasible to ensure continued access to rotary
wing air ambulance services, particularly in rural areas;
``(IV) the extent to which any such criteria is technically
feasible, taking into account the ability of existing
aircraft to comply with any such standards, as well as the
market availability and future development of equipment and
products that can be installed on or carried aboard existing
rotary wing aircraft; and
``(V) the incorporation of any such criteria during
appropriate implementation timeframes with the goal of
transitioning toward higher caliber criteria for
beneficiaries under this title over a reasonable period of
time and in a manner that does not impede access to rotary
wing air ambulance services, particularly in rural areas; and

``(iii) ensure that the process of developing such criteria
is undertaken through a transparent process that provides for
input from various stakeholders, including organizations
representing physicians and other medical professionals,
State, or local governments that own and operate air
ambulance services, organizations representing air medical
suppliers or providers, patient organizations, State
emergency medical services, public health officials, and any
other stakeholders determined appropriate by the Secretary
(acting through the Administrator of the Centers for Medicare
& Medicaid Services) or the Administrator of the Federal
Aviation Administration, respectively.
``(B) Regular updating of criteria.--The Secretary (acting
through the Administrator of the Centers for Medicare &
Medicaid Services) and the Administrator of the Federal
Aviation Administration shall ensure that the criteria
developed under paragraphs (3) and (4), respectively, are
reviewed not less than frequently than every 2 years and
updated as appropriate to reflect consideration of new
medical and aviation standards, technologies, and equipment.
``(6) Incorporation of accreditation criteria.--
``(A) In general.--The Secretary shall combine the criteria
developed by the Secretary (acting through the Administrator
of the Centers for Medicare & Medicaid Services) under
paragraph (3) and the criteria developed by the Administrator
of the Federal Aviation Administration under paragraph (4)
into a single set of final criteria and ensure that
accreditation organizations designated under paragraph (2)(A)
apply such set of final criteria as substantive requirements
in the accreditation process established under paragraph (1).
``(B) Review.--The Secretary shall review such set of final
criteria to ensure that, taken as a whole, such criteria are
consistent with the requirements of clauses (i) and (ii) of
paragraph (5)(A). If the Secretary determines that such set
of final criteria is not consistent with such requirements,
the Secretary shall request that the Secretary (acting
through the Administrator of the Centers for Medicare &
Medicaid Services) and the Administrator of the Federal
Aviation Administration modify such criteria in accordance
with the process described in paragraphs (3), (4), and (5).
``(7) Grandfather protection for aircraft presently
providing rotary wing air ambulance services.--
``(A) In general.--Subject to subparagraph (B), the
Secretary shall exempt any rotary wing air ambulance listed
on a currently valid operating certificate with A021 air
ambulance operations specifications pursuant to parts 119 and
135 of title 14, Code of Federal Regulations or any air
ambulance for which a contractual obligation to purchase such
air ambulance had been entered into prior to the date of
enactment of the Patient Protection and Affordable Care Act,
from compliance with any accreditation criteria developed
under paragraphs (3), (4), and (5) or incorporated under
paragraph (6), if, as determined by the Administrator of the
Federal Aviation Administration in consultation with the
Secretary (acting through the Administrator of the Centers
for Medicare & Medicaid Services), compliance with such
criteria would require the replacement of such aircraft or
impose an undue economic burden on a supplier or provider of
rotary wing air ambulance services with respect to compliance
costs.
``(B) Limitation.--The exemption authority under
subparagraph (A) shall not apply to any new or used aircraft
purchased after the date of enactment of the Patient
Protection and Affordable Care Act (including aircraft
purchased as a replacement for an existing aircraft) unless
the supplier or provider was under contractual obligation to
purchase such air ambulance prior to such date of enactment.
``(8) Relationship to other laws and authorities.--Nothing
in this section shall--
``(A) limit the authority of the Federal Aviation
Administration over civil aviation or infringe upon any
regulations or guidance respecting civil aviation safety;
``(B) affect the provisions of or requirements under
section 41713(b) of title 49, United States Code; or
``(C) affect the authority of States to license providers
of air ambulance services or medical personnel aboard such
air ambulances, except to the extent otherwise prohibited by
law, including such section 41713(b).''.

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