Public Policy / Public Affairs

Senator Cantwell Introduces Safety Bill, S. 1199
House Passes New Air Med Reqs in FAA Reauthorization Bill
Congressional Hearings
FAA OpSpec A021 Changes, Future Rulemaking Initiative
Medicare Bill Moves through Congress
AAMS Supports Expansion of the Public Safety Officer Benefit Program

Senator Cantwell Introduces Safety Bill, S. 1199.
Senator Cantwell has officially introduced her safety bill, S. 1199.  CLICK HERE to read the text of the bill.  This year's bill is very much like her bill of last year, S. 3329, with two differences. 

First, while last year's bill required any aircraft used for EMS operations ordered after the effective date of enactmment to have on board a device that performs the function of TAWS, this year's bill would require such a TAWS device on any aircraft used for EMS after one year of enactment.

Second, this year's version has a reporting requirement.  Certificate holders would report annually to the FAA the number of helicopters and aircraft used, their base locations and registration numbers, and the number of flights and hours flown.  Additionally, for each helicopter or aircraft, certificate holders would report the number of flights and purpose of each flight.  The FAA would then report this information to Congress.

House passes new air med requirements in FAA Reauthorization Bill
Late Thursday, May 21st, the US House of Representatives passed its FAA Reauthorization bill containing a number of provisions dealing with air medical services, affecting AAMS members operating both medical helicopters, as well as fixed wing aircraft.

The provisions are fairly lengthy, taking up 11 pages in the bill, and can be found in Sections 312, 313, and 314 of H.R. 915. Here is a summary of the provisions:

Section 312 – Safety of Helicopter Air Ambulance Operations

1. The FAA would be required to conduct rulemaking (i.e., write a regulation) about various aspects of Part 135 medical helicopter operations in the name of safety. This new rule(s) will include:

• Flight Request & performance-based dispatch procedures
• Pilot training standards, including requirements, time limitations for completing training, content of the training, CRM, flight risk evaluation, preventing CFIT, recovery from IIMC, operational control, and use of flight simulation and line-oriented flight training.
• Safety enhancing technology & equipment, including HTAWS, radar altimeters, personal protective equipment (helmets, shoulder harnesses, seat belts, and fire-resistant clothing), and devices that perform the function of flight data recorders and cockpit voice recorders.
• Flight risk evaluation programs will be required to be established and utilized.
• Operational control centers will be required for all certificate holders with 10 or more helicopters.
• All air medical operations must be operated under all Part 135 regulations, including weather minima and flight and duty time requirements.
• The notice of proposed rulemaking must be completed within 180 days after the date of enactment of the bill, and the final rule must be issued within 16 months after the close of the comment period following the issuance of the notice of proposed rulemaking.

2. FAA Data Collection
The FAA will require Part 135 operators of medical helicopters to submit an annual report to the FAA with at least the following data points:

• # of helicopters per operator
• Base locations of these helicopters
• Number of flights flown per helicopter
• Number of flight hours flown per helicopter
• Number of flight requests accepted & declined
• Type of flight requests accepted and declined (scenes, interfacility, organ transport, ferry/repositioning)
• Number of accidents and description of these accidents per certificate holder
• Number of flights flown under IFR
• Number of flight hours flown under IFR
• Time of day each flight is flown

A report summarizing the data collected must be submitted by the FAA to Congress within 2 years.

3. FAA Study on requiring NVGs for night flights
The FAA will be required to conduct a study on the feasibility of requiring use of NVGs for all night-time Part 135 medical helicopter operations. The study must be done in concert with owners and operators of medical helicopters. The study must be completed and submitted to Congress within one year.

4. Study on helicopter and fixed wing air ambulance services
The Comptroller General will be required to conduct a study that will include a review of the industry, including certificate holders and indirect air carriers, providing helicopter and fixed wing services. Included in this review will be:

• Number, size and location of aircraft & bases
• Affiliations of certificate holders and indirect carriers with hospitals, governments and other entities
• Coordination of air ambulance services with each other, state and local EMS systems, referring agencies and receiving hospitals
• Nature of services contracts, sources of payment, financial relationships between certificate holders and indirect carriers and their referring entities
• Costs of operations
• Business models, including their structure, expenses and sources of income.

The study must also include information about air medical request and dispatch practices, protocols, models, training, certifications, and air medical communication centers, in particular:

• Practices used to request an air ambulance
• Factors leading to inappropriate or unsafe requests for transport
• Factors leading to delays in air ambulance transport.

The study must also include information about economic and medical issues, such as:

• Licensing
• Certificates of Need
• Public convenience and necessity
• Assignment of coverage areas
• Accreditation
• Compliance with dispatch procedures
• Requirements for medical equipment and personnel

The final report must include an analysis and recommendations from Comptroller General on:

• The relationship between state and federal regulations of air ambulances
• The extent to which federal law may impact state regulation of air ambulances
• The potential effect of greater state regulation on:

Economic viability
Availability and coordination of service
Costs of operations in rural and highly populated areas
Quality of patient care and outcomes
On competition and safety

• Identification of systemic or other problems exist on a statewide, regional or national basis with current system of governing air ambulances.

5. This report will be due to Secretary of the Department of Transportation and to Congress by June 1, 2010.

6. By August 1, 2010, the Secretary of the Department of Transportation shall issue a report to Congress with plans for new regulations and recommendations for new legislation based on this Comptroller General’s report.

This language was passed by the full House last week. Click here to see a copy of the complete language. At the time of publication, the Senate has not yet addressed air medical safety issues in any bill.  AAMS will provide updates to the membership as additional information becomes available.

Interested in working on the association’s responses to this and other public policy initiatives? Consider joining the AAMS Government Relations Committee! Contact Dawn Mancuso at (703) 836-8732 for more information.

Congressional Hearings Scheduled for Wednesday, April 22nd on Capitol Hill
The House Aviation Sub-committee has scheduled a hearing entitled “Oversight of Helicopter Medical Services” to take place on Wednesday, April 22nd in Washington, DC.  The hearing will start at 1000h and run all day featuring two distinct panels.  The first will be a government panel, followed by a second panel of industry experts. 

AAMS has been notified that we will be receiving an invitation to testify.  We will also be providing written testimony similar to the procedure followed for the NTSB hearings in early February. 

Details are still becoming available.  Please watch your e-mails for special member alerts concerning the upcoming Congressional hearing.

FAA OpSpec A021 Changes, Future Rulemaking Initiative
The FAA has proposed changes to both Operations Specifications (OpSpecs) A021, Helicopter Emergency Medical Service Operations, and A050, Helicopter Night Vision Goggle Operations.

View the Federal Register Notice on the current proposed changes to Operations Specification A021and A050 - click here.
Download the proposed changes to Operations Specification A021 - click here.
Download the proposed changes to Operations Specification A050 - click here.

The following is a description of these change from the Federal Register dated Friday, November 14, 2008:

The FAA has determined that safety in air commerce and the public interest requires additional hazard mitigation for HEMS operations, and therefore has revised Operations Specifications A021 and A050 pursuant to 14 CFR 119.51.

The A021 revisions specify that if a flight, or sequence of flights, includes a part 135 segment then all visual flight rules (VFR) segments of the flight must be conducted within the weather minimums and minimum safe cruise altitude determined in pre-flight planning. Specifically, A021 requires pilots to identify a minimum safe cruise altitude during pre-flight planning by identifying and documenting obstructions and terrain along the planned flight path. HEMS pilots must also determine the minimum required ceiling and visibility to conduct the flight using the revised weather minimums contained in A021.

Revised Operations Specification A021 also permits HEMS instrument flight rules (IFR) operations at landing areas without weather reporting if an approved weather reporting source is located within 15 nautical miles of the landing area or if an area forecast is available.

Revised Operations Specification A050 changes weather minimums for HNVGO conducted in Class G Airspace to be consistent with changes made to the Class G Airspace minimums in A021.

The full text of the changes to Operations Specifications A021 and A050 are available on the FAA Web site and on http://www.regulations.gov as discussed above.

Also available on the website are slides from a presentation made by Dennis Pratte, Manager of the FAA’s AFS-250 office, regarding both the OpSpec changes and long term plans to address several issues with a formal rulemaking. Among those issues may be some requirement for helicopter terrain alert warning systems (H-TAWS), and devices that would perform the function of recording flight data and voice communication. These recording devices may include video or software based devices that are currently available but do not meet the current “Cockpit Voice and Flight Data Recorder” definitions at the FAA, which refer to specific devices often found in large fixed wing aircraft. To view the presentation, click here. 

Air Medical Services: future development as an integrated component of the Emergency Medical Services (EMS) System: a guidance document by the Air Medical Task Force of the National Association of State EMS Officials, National Association of EMS Physicians, and Association of Air Medical Services.
Prehospital Emergency Care. 2007 Oct-Dec; 11(4):353-68.

For the portion of H.R. 6331 concerning Air Medical Services, click here.

Medicare Bill Moves through Congress
The Congress passed the Medicare Improvement Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) on July 15th over the President’s veto. The bill included two provisions specific to air medical services:

• An 18 month hold-harmless for air medical services negatively affected by changes to the urban/rural coding of certain transports. This is hold-harmless will begin on July 1st, 2008, and end on December 31st, 2009, and will reimburse zip codes that were previously considered rural but now considered urban at the previous rural rate.
• A technical change that helps to clarify previously passed legislation outlining who may be authorized to call for air medical transport. The intent of this change is to reduce the number of audits to Medicare claims, especially when a physician or other medically trained individual is willing to certify, even after the transport has taken place, that they made the request.

AAMS has met with CMS on the implementing these changes in CMS policy and CMS will need some time to implement the policy changes. It has already been established that CMS will task the carriers with the responsibility of providing payments to providers based on the zip code hold-harmless retroactively to July 1, 2008. Both changes, although technical, should provide some reimbursement relief, especially in those areas negatively affected by the zip code change.

AAMS Supports Expansion of the Public Safety Officer Benefit Program
Congressman Keith Ellison (D- MN 5th) introduced legislation that would extend benefits offered by the Department of Justice to public safety officers killed or injured in the line of duty to public safety officers who may be employed by the private sector.

• The bill, H.R. 3822, was introduced on October 12th by Congressman Ellison after requests from the Minnesota ambulance community following the numerous efforts undertaken by both public and private EMS services surrounding the Minneapolis bridge collapse earlier this year.
• AAMS, along with numerous other organizations representing various facets of the EMS community, including the American Ambulance Association (AAA) and the International Association of Flight Paramedics (IAFP), supports this legislation through the Congressional Air Medical Caucus and individual lobbying efforts.

                    Issue: Support the extension of public safety officer benefits to the
                          employees of private services by passing the Public Safety
                          Officer Benefit extension bill, H.R. 3822.

                   Action: AAMS members are encouraged to contact their local 
                          congressional representative and ask him or her to co-
                          sponsor H.R. 3822, or ask that office to contact Christopher 
                          Eastlee directly at (703) 836-8732 for more information. 

For a copy of this bill, H.R. 3822, click here.