,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #cghj  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,septemb] #ad1        
#bjag,mr4 ,hudson 7= himself1 ,mr4      
,k5n$y1 ,ms4 ,j5k9s ( ,kansas1 & ,mr4   
,k9d7 introduc$ ! foll[+ bill2 :i* 0    
ref]r$ to ! ,committee on ,en]gy &      
,comm]ce1 & 9 addition to ! ,committee  
on ,ways & ,means1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
provide "u ! ,m$ic>e program =          
conditions ( p>ticipation1 report+      
requirem5ts1 & a quality program )      
respect to air ambulance s]vices4  #a4  
,%ort title ,?is ,act may be cit$ z !   
,air ,ambulance ,quality &              
,acc\ntability ,act4  #b4 ,f9d+s        
,congress f9ds z foll[s3  7#a7 ,pati5t  
access to high quality & ess5tial air   
ambulance s]vices c mean ! diff]5ce     
betwe5 life & dea? & quality ( survival 

= pati5ts4  7#b7 ,m$ic>e %\ld assure    
b5efici>ies ( high quality air ambulance
 s]vices & pati5t safety4  7#c7 ,m$ic>e 
has no requirem5ts relat$ to quality    
measurem5t & report+1 adh]5ce to        
relevant /&>ds z a condition (          
p>ticipat+ 9 ,m$ic>e1 & robu/ co/       
report+4  7#d7 ,m$ic>e curr5tly         
reimburses all suppli]s & provid]s ( air
 ambulance s]vices ! same1 reg>dless (  
cl9ical capability or inve/m5t 9        
aviation safety t exce$s requirem5ts ( !
 ,f$]al ,aviation ,adm9i/ration4  7#e7  
,a subset ( pati5ts requir+ air         
transport are s critically ill or injur$
 z to require an advanc$ level ( cl9ical
 capability to address un/able &        
life-?reat5+ m$ical conditions t may    
develop or det]iorate dur+ transport4 ,!
 co/s ( provid+ c>e to su* pati5ts %\ld 
be report$ to enable ! ,congress to     
assess ! suffici5cy & appropriat5ess (  
reimbursem5t = ^! mo/ vuln]able pati5ts4
  7#f7 ,!re rema9 _m geographic areas ( 
! nation ) limit$ access to air         

ambulance s]vices due to l[ volume (    
pati5ts 9 geographically isolat$ & v    
rural areas4  7#g7 ,m$ic>e & ,m$icaid   
paym5t %\ld be adequate to protect &    
promote access to air ambulance s]vices 
t are capable ( meet+ ! cl9ical ne$s ( !
 mo/ critically ill & injur$ pati5ts1   
all[ necess>y inve/m5ts 9 transport     
safety1 & enable transport to !         
appropriate m$ical c5t] to receive !m4  
7#h7 ,an evaluation ( ,m$ic>e paym5t    
policy is w>rant$ to assess & secure    
recomm5dations ab\t paym5t adequacy =   
air ambulance provid]s & suppli]s & !   
reali/ic co/s ( provid+ ?is life-sav+   
transport s]vices4  7#i7 ,m&atory co/   
report+ is necess>y = air ambulance     
s]vices provid]s receiv+ ,m$ic>e        
reimbursem5t to ensure fair & adequate  
reimbursem5t & all[ appropriate access4 
7#aj7 ,su* report+ %\ld also capture    
ess5tial data ) reg>d to access1 co/1   
utilization1 quality & v>iation ( su*   
s]vices to enable m specifically n>r[ly 
tailor+ paym5ts comm5surate ) high] co/s

 actually incurr$ su* z ^? treat+ ! mo/ 
critically ill & injur$1 inve/+ 9 high] 
co/ aviation safety & airframes1 & s]v+ 
pati5ts 9 ! mo/ geographically isolat$  
areas4  #c4 ,/&>ds = air ambulance      
provid]s & suppli]s  7a7 ,m9imum /&>ds  
,section #ahcd7l7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciem7l77 is am5d$ 
by add+ at ! end ! foll[+ new p>agraph3 
7#ag7 ,m9imum /&>ds = air ambulance     
provid]s & suppli]s  7,a7 ,9 g5]al ,n   
lat] ?an #b ye>s aft] ! date ( !        
enactm5t ( ?is p>agraph1 ! ,secret>y    
%all1 9 consultation ) relevant         
/akehold]s1 e/abli% m9imum /&>ds :i* air
 ambulance suppli]s & provid]s w\ld be  
requir$ to satisfy z a condition (      
p>ticipation "u ?is title4  7,b7 ,air   
ambulance m9imum /&>ds ,9 e/abli%+ !    
m9imum /&>ds "u subp>agraph 7,a71 !     
,secret>y %all include at lea/ m9imum   
/&>ds ) respect to ! foll[+3  7i7 ,scope
 ( practice1 tra9+ & cl9ical capability 
( m$ical p]sonnel relevant to m$ical    
condition ( pati5ts transport$4  7ii7   

,m$ical equipm5t 7su* z pati5t monitor+1
 respiratory & hemodynamic & o!r        
relevant pati5t support equipm5t71      
devices1 te*nology & =mul>ies4  7iii7   
,vehicle attributes to support ne$$ c>e1
 includ+ configuration & conditions (   
m$ical environm5t1 electrical supply 9  
air ambulance & o!r relat$ equipm5t4    
7iv7 ,docum5tation /&>ds1 su* z pati5t  
c>e records1 timel9e ( c>e & transport1 
hi/ory ( pres5t illness & assessm5ts1 & 
docum5tation specific to diagno/ic &    
!rapeutic proc$ures4  7v7 ,m$ical       
direction & physician m$ical ov]sight1  
su* z cr$5tials ( su* physicians4  7vi7 
,report+ ( always ev5ts1 su* z c>e      
coord9ation & transition1 pa9 managem5t1
 prev5t+ v5tilator acquir$ pneumonia or 
invasive l9e or w\nd infections4  7vii7 
,report+ ( nev] ev5ts1 su* z loss (     
oxyg51 deliv]y ( a baby dur+ transport1 
pati5t dea? or disability due to vehicle
 failure or cra%1 transport to un9t5d$  
de/9ation1 dropp+ a pati5t or all[+ a   
fall dur+ movem5t ( pati5t1 failure to  

communicate "t ( arrival1 hypoglycemia1 
& m$ication errors4  7viii7 ,pati5t     
safety & infection control4  7ix7       
,physician direct$ cl9ical quality      
managem5t & cl9ical p]=mance improvem5t 
programs includ+ quality assurance1     
utilization review1 outcomes1 pr(ici5cy 
measures & pati5t safety4  7x7 ,/&>ds   
relevant to p>ticul> populations1 su* z 
^? on balloon pumps or ,,ecmo4  7,c7    
,deem$ /atus ,air ambulance provid]s &  
suppli]s t are accr$it$ by an           
accr$itation organization approv$ by !  
,secret>y z hav+ /&>ds t meet or exce$ !
 ,secret>y's /&>ds = su* provid]s %all  
be deem$ to be 9 compliance ) ! m9imum  
requirem5ts requir$ pursuant to ?is     
p>agraph4  4  #d4 ,air ambulance co/    
report+ program ,section #ahcd7l7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7l771 z am5d$ by section #c1 is   
fur!r am5d$ by add+ at ! end ! foll[+   
new p>agraph3  7#ah7 ,air ambulance co/ 
report+ program  7,a7 ,9 g5]al ,= ! fir/
 ye> beg9n+ at lea/ #ab mon?s aft] !    

date ( ! enactm5t ( ?is p>agraph & ea*  
subsequ5t ye>1 an air ambulance provid] 
or suppli] ( air ambulance s]vices %all 
submit to ! ,secret>y 79 a =m & mann] & 
at su* "t z specifi$ by ! ,secret>y7    
data describ$ 9 subp>agraph 7,b7 = !    
report+ p]iod 7z specifi$ by !          
,secret>y7 = su* ye>4  7,b7 ,co/ data ,=
 purposes ( report+ data "u ?is = air   
ambulance s]vices furni%$ ) respect to a
 ye>1 ! data describ$ 9 ?is subp>agraph 
are co/ data specifi$ by ! ,secret>y    
relat+ to ! foll[+3  7i7 ,geographic    
location factors1 includ+ mileage &     
numb] ( provid]s 9 ! s]vice area4  7ii7 
,capital & op]ational co/s1 su* z ! type
 ( aircraft1 includ+ fix$ w+ aircraft1  
rot>y w+ aircraft--s+le or tw9 eng9e1   
in/rum5t$ flight or visual flight4      
7iii7 ,ma9t5ance ( aircraft1 includ+    
avionics1 communications equipm5t1 fuel1
 & g5]al repairs4  7iv7 ,ma9t5ance (    
equipm5t1 includ+ specialty cl9ical     
equipm5t4  7v7 ,m$ical supplies4  7vi7  
,employee exp5ses1 includ+ sal>ies &    

insurance 7life1 heal?1 & liability74   
7vii7 ,build+ exp5ses1 includ+ r5t &    
ma9t5ance4  7viii7 ,any o!r co/s z      
specifi$ by ! ,secret>y1 9 consultation 
) ! ,secret>y ( ,transportation1 z ne$$ 
to be includ$ "u ?is subp>agraph =      
purposes ( in=m+ ! report & evaluation  
"u section #f ( ! ,air ,ambulance       
,quality & ,acc\ntability ,act or =     
purposes ( enabl+ ,congress to make     
appropriate det]m9ations ab\t paym5t "u 
?is section to air ambulance provid]s & 
suppli]s4  ,! ,secret>y1 9 consultation 
) provid]s & suppli]s ( air ambulance   
s]vices1 %all p]iodically update1 z     
det]m9$ necess>y by ! ,secret>y1 ! co/  
data specifi$ pursuant to ?is           
subp>agraph4  7,c7 ,susp5sion ( paym5t =
 failure to report  7i7 ,9 g5]al ,)     
respect to air ambulance s]vices furni%$
 by a suppli] or provid] ( air ambulance
 s]vices dur+ ! second ye> beg9n+ at    
lea/ #ab mon?s aft] ! date ( ! enactm5t 
( ?is p>agraph or any subsequ5t ye>1 9 !
 case t ! suppli] or provid] does n     

submit data to ! ,secret>y 9 accordance 
) subp>agraph 7,a7 = ! report+ p]iod    
applicable to su* ye> 7:i* %all be dur+ 
! previ\s ye>71 ! ,secret>y %all susp5d 
paym5ts "u ! fee s*$ule "u ?is          
subsection = air ambulance s]vices      
furni%$ by su* suppli] or provid] dur+  
su* ye> until su* suppli] or provid]    
submits su* data 9 accordance ) su*     
subp>agraph4  7ii7 ,treatm5t ( new      
,m$ic>e suppli]s & provid]s ( air       
ambulance s]vices ,9 ! case ( a suppli] 
or provid] ( air ambulance s]vices t    
fir/ becomes a ,m$ic>e enroll$ suppli]  
or provid] ( air ambulance s]vices dur+ 
! report+ p]iod applicable to a ye> )   
respect to :i* clause 7i7 applies 7& _h 
n previ\sly submitt$ claims "u ?is title
 su* z a p]son or entity or "u a diff]5t
 bill+ numb] or tax id5tifi]71 su*      
suppli] or provid] %all n be subject to 
clause 7i7 until ! subsequ5t ye> & )    
respect to data requir$ to be submitt$ =
 ! report+ p]iod applicable to su*      
subsequ5t ye>4  4  #e4 ,air ambulance   

quality report+ program ,section        
#ahcd7l7 ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #aciem7l771 z am5d$ by       
sections #c & #d1 is fur!r am5d$ by add+
 at ! end ! foll[+ new p>agraph3  7#ai7 
,air ambulance quality report+ program  
7,a7 ,paym5t bas$ on p]=mance  7i7 ,9   
g5]al ,! ,secret>y %all e/abli% an air  
ambulance quality report+ & p]=mance    
program "u :i*--  7,i7 ) respect to air 
ambulance s]vices furni%$ by a suppli]  
or provid] ( air ambulance s]vices dur+ 
! fir/ consequ5ce ye>1 second consequ5ce
 ye>1 or ?ird consequ5ce ye>1 9 ! case t
 ! suppli] or provid] does n submit a   
report1 ) respect to ! p]=mance p]iod = 
su* ye>1 9 accordance ) subp>agraph     
7,c71 aft] det]m9+ ! p]c5tage increase  
"u p>agraph 7#c77;,b71 & aft]           
application ( p>agraphs 7#c77;,c7 &     
7#ah71 ! ,secret>y %all r$uce su*       
p]c5tage increase = paym5ts "u ! fee    
s*$ule "u ?is subsection dur+ su* ye> by
 #b p]c5tage po9ts2 &  7,,ii7 ) respect 
to air ambulance s]vices furni%$ by a   

suppli] or provid] ( air ambulance      
s]vices dur+ a consequ5ce ye> aft] !    
?ird consequ5ce ye>1 ! ,secret>y applies
 a p]c5tage po9t adju/m5t to ! p]c5tage 
increase det]m9$ "u p>agraph 7#c77;,b71 
aft] application ( p>agraphs 7#c77;,c7 &
 7#ah71 9 a mann] t provides =          
diff]5tial paym5t to a suppli] or       
provid] ( air ambulance s]vices bas$ ^u 
! quality ( c>e furni%$ 7z det]m9$ "u   
subp>agraph 7,b77 dur+ a p]=mance p]iod 
) respect to su* consequ5ce ye> 7) su*  
p]c5tage po9t adju/m5t rang+ f an       
increase ( #e p]c5tage po9ts = su*      
s]vices furni%$ 9 a consequ5ce ye> by   
su* a provid] or suppli] ) ! highe/     
demon/rat$ p]=mance 9 ! p]=mance p]iod =
 su* ye> to a decrease ( #e p]c5tage    
po9ts = su* s]vices furni%$ 9 !         
consequ5ce ye> by su* a provid] or      
suppli] ) ! l[e/ demon/rat$ p]=mance = !
 p]=mance p]iod = su* ye>74  7ii7       
,special rule ,! application ( ?is      
subp>agraph may result 9 su* p]c5tage   
increase be+ less ?an #j4j = a ye>1 &   

may result 9 paym5t rates "u ! fee      
s*$ule "u ?is subsection = a ye> be+    
less ?an su* paym5t rates = ! prec$+    
ye>4  7iii7 ,noncumulative application  
,any adju/m5t "u ?is subp>agraph %all   
apply only ) respect to ! ye> involv$ & 
! ,secret>y %all n take into acc\nt su* 
adju/m5t 9 comput+ ! paym5t am\nt "u !  
fee s*$ule "u ?is subsection = a        
subsequ5t ye>4  7iv7 ,treatm5t ( new    
,m$ic>e suppli]s & provid]s ( air       
ambulance s]vices ,9 ! case ( a suppli] 
or provid] ( air ambulance s]vices t    
fir/ becomes a ,m$ic>e enroll$ suppli]  
or provid] ( air ambulance s]vices dur+ 
! p]=mance p]iod = a consequ5ce ye> 7&  
_h n previ\sly submitt$ claims "u ?is   
title su* z a p]son or entity or "u a   
diff]5t bill+ numb] or tax id5tifi]71 ! 
adju/m5t "u clause 7i7 %all n apply to  
su* suppli] or provid] until ! subsequ5t
 consequ5ce ye> & p]=mance p]iod = su*  
subsequ5t consequ5ce ye>4  7,b7 ,det]m9+
 p]=mance  7i7 ,9 g5]al ,"u ! air       
ambulance quality report+ & p]=mance    

program1 ! p]=mance ( a provid] or      
suppli] ( air ambulance s]vices )       
respect to a p]=mance p]iod ) respect to
 a consequ5ce ye> aft] ! ?ird consequ5ce
 ye> %all be det]m9$ z specifi$ by !    
,secret>y bas$ on data requir$ "u       
subp>agraph 7,c7 to be submitt$ 79 a =m 
& mann] & at su* "t z specifi$ by !     
,secret>y7 by ! provid] or suppli] = su*
 p]=mance p]iod = ! consequ5ce ye>4     
7ii7 ,treatm5t ( non-report]s ,"u ! air 
ambulance quality report+ & p]=mance    
program1 = purposes ( subp>agraph 7,a71 
any provid] or suppli] ( air ambulance  
s]vices :o does n submit data requir$ "u
 subp>agraph 7,c7 to submitt$ = a       
p]=mance p]iod ) respect to a consequ5ce
 ye> aft] ! ?ird consequ5ce ye>1 %all be
 treat$ z if su* provid] or suppli] _h !
 l[e/ demon/rat$ p]=mance = ! p]=mance  
p]iod = su* ye>4  7,c7 ,report+  7i7 ,9 
g5]al ,= purposes ( ?is p>agraph = ye>s 
beg9n+ ) ! fir/ consequ5ce ye>1 an air  
ambulance provid] or suppli] %all submit
 to ! ,secret>y a report1 ) respect to !

 p]=mance p]iod = su* ye>1 on--  7,i7 ! 
measures describ$ 9 subp>agraph 7,d77i72
  7,,ii7 9 ! case ( a consequ5ce ye>    
be=e ! f\r? consequ5ce ye>--  7aa7 at   
lea/ #b ( ! measures describ$ 9         
subp>agraph 7,d77ii77,i72 &  7bb7 at    
lea/ #b ( ! measures e/abli%$ "u        
subp>agraph 7,d77iii77,i72 &  7,,iii7 9 
! case ( a consequ5ce ye> beg9n+ ) !    
f\r? consequ5ce ye>-- 7aa7 at lea/ #d ( 
! measures describ$ 9 subp>agraph       
7,d77ii77,,ii72 &  7bb7 at lea/ #d ( !  
measures e/abli%$ "u subp>agraph        
7,d77iii77,,ii74  7ii7 ,availability (  
data ,! ,secret>y %all e/abli% proc$ures
 = mak+ data submitt$ "u clause 7i7     
available to ! public4 ,su* proc$ures   
%all ensure t--  7,i7 data submitt$ "u  
clause 7i7 = ! fir/ consequ5ce ye> %all 
n be made public2 &  7,,ii7 an air      
ambulance provid] or suppli] has !      
opportunity to review ! data t is to be 
made public ) respect to ! air ambulance
 provid] or suppli] prior to su* data   
be+ made public4  7,d7 ,measures ,9     

e/abli%+ ! quality program "u           
subp>agraph 7,a71 ! foll[+ %all apply3  
7i7 ,ov]-triage ,! ,secret>y %all       
provide = ! application ( a measure )   
respect to ov]-triage 9 mode (          
transportation4  7ii7 ,pati5t safety    
measures ,! ,secret>y %all1 9           
consultation ) provid]s & suppli]s ( air
 ambulance s]vices1 e/abli%--  7,i7 )   
respect to a p]=mance p]iod ) respect to
 a consequ5ce ye> be=e ! f\r? consequ5ce
 ye>1 at lea/ #c pati5t safety measures 
= provid]s & suppli]s ( air ambulance   
s]vices2 &  7,,ii7 ) respect to a       
p]=mance p]iod ) respect to a consequ5ce
 ye> beg9n+ ) ! f\r? consequ5ce ye>1 at 
lea/ #f pati5t safety measures =        
provid]s & suppli]s ( air ambulance     
s]vices4  7iii7 ,cl9ical quality        
measures ,! ,secret>y %all1 9           
consultation ) provid]s & suppli]s ( air
 ambulance s]vices1 e/abli%--  7,i7 )   
respect to a p]=mance p]iod ) respect to
 a consequ5ce ye> be=e ! f\r? consequ5ce
 ye>1 at lea/ #c cl9ical quality        

measures = provid]s & suppli]s ( air    
ambulance s]vices2 &  7,,ii7 ) respect  
to a p]=mance p]iod ) respect to a      
consequ5ce ye> beg9n+ ) ! f\r?          
consequ5ce ye>1 at lea/ #f cl9ical      
quality measures = provid]s & suppli]s (
 air ambulance s]vices4  7iv7 ,updates  
,! ,secret>y1 9 consultation ) provid]s 
& suppli]s ( air ambulance s]vices1 %all
 p]iodically update1 z det]m9$ necess>y 
by ! ,secret>y1 ! measures to be appli$ 
pursuant to ?is subp>agraph4  7,e7      
,def9itions ,= purposes ( ?is p>agraph3 
7i7 ,! t]m consequ5ce ye> means a ye>   
beg9n+ ) ! #e? ye> />t+ at lea/ #ab     
mon?s aft] ! date ( ! enactm5t ( ?is    
p>agraph4 ,! t]ms fir/ consequ5ce ye>1  
second consequ5ce ye>1 & ?ird consequ5ce
 ye> mean su* #e? ye> />t+ at lea/ #ab  
mon?s aft] su* date ( enactm5t1 ! #f?   
ye> />t+ at lea/ #ab mon?s aft] su* date
 ( enactm5t1 & ! #g? ye> />t+ at lea/   
#ab mon?s aft] su* date ( enactm5t1     
respectively4  7ii7 ,! t]m p]=mance     
p]iod means1 ) respect to a consequ5ce  

ye>1 su* p]iod z specifi$ by !          
,secret>y4  4  #f4 ,med,p,a,c /udy on   
access1 quality1 co/s1 & reimbursem5t   
7a7 ,evaluation ,n lat] ?an ?ree ye>s   
aft] ,decemb] #ca ( ! fir/ ye> to :i*   
p>agraph 7#ah7 ( section #ahcd7l7 ( !   
,social ,security ,act1 z add$ by       
section #d1 applies1 ! ,m$ic>e ,paym5t  
,advisory ,commission %all submit to    
,congress a report conta9+ an evaluation
 ( ! co/s ( air provid]s & suppli]s4    
,su* evaluation %all--  7#a7 be d]iv$ f 
! co/ & o!r data submitt$ "u su*        
p>agraph 7#ah7 ( su* section #ahcd7l72 &
  7#b7 diff]5tiate z appropriate to     
recognize v>iation or high] co/s relat$ 
to-- 7,a7 aviation in/rum5t flight      
control2  7,b7 provision ( c>e to       
critically ill or injur$ pati5ts2  7,c7 
! provision ( s]vices 9 geographically  
isolat$ areas2 &  7,d7 ! provision ( c>e
 to un9sur$ individuals4  7b7           
,recomm5dations ,z "p ( ! report        
submitt$ "u subsection 7a71 ! ,m$ic>e   
,paym5t ,advisory ,commission %all      

provide recomm5dations on :e!r *anges   
%\ld be made ) reg>d to reimbursem5t (  
air ambulance provid]s & suppli]s "u    
title ,,xviii ( ! ,social ,security ,act
 bas$ ^u ! data submitt$ "u p>agraph    
7#ah7 ( section #ahcd7l7 ( ! ,social    
,security ,act1 z add$ by section #d1   
tak+ into consid]ation v>iables affect+ 
paym5t adequacy "u su* title = & its    
impact on ,m$ic>e b5efici>ies1 includ+--
  7#a7 :e!r paym5t "u su* title is      
suffici5t to ensure access to air       
ambulance s]vices or %\ld be alt]$1     
includ+ :e!r paym5t %\ld be high] = air 
ambulance provid]s & suppli]s--  7,a7 ) 
high] levels ( cl9ical capability to    
s]ve ! mo/ critically ill & injur$      
pati5ts2 &  7,b7 t utilize advanc$ &    
exp5se avionics su* z ,in/rum5t ,flight 
,rules2  7#b7 :e!r uncomp5sat$ c>e borne
 by air ambulance provid]s & suppli]s   
imp$es access2  7#c7 ! degree to :i* !re
 is v>iation 9 ! utilization ( air      
ambulance s]vices on a p] capita & p]   
transport basis1 includ+ :e!r !         

und]supply or ov]supply ( helicopt]s or 
fix$ w+ aircraft 9 a geographic region  
affects access & ! volume & adequacy (  
paym5ts "u su* title ) reg>d to su*     
utilization2  7#d7 ! degree to :i*      
memb]%ip programs are utiliz$ by air    
ambulance provid]s & suppli]s to su/a9  
_! op]ations1 & if rev5ue f memb]%ip    
programs is us$ to r$uce _! co/s or     
provide capital fund+1 & :e!r su*       
programs are b5eficial to ,m$ic>e       
b5efici>ies2  7#e7 ! degree (           
subsidization t occurs f private insur]s
 or hospitals sponsor+ air ambulance    
provid]s or suppli]s to cov] inadequate 
paym5ts "u title ,,xviii or ,,xix ( !   
,social ,security ,act & enable         
reasonable pr(itability2  7#f7 ! ratio (
 *>ges to ,m$ic>e reimbursem5t & !      
impact on b5efici>y co/ %>+ ( co/1      
utilization1 & v>iation 9 air ambulance 
s]vices2  7#g7 appropriate f9ancial or  
o!r inc5tives = ! utilization ( gr\nd   
critical c>e transport :]e m$ically     
appropriate2  7#h7 ! degree to :i* a    

quality report+ & p]=mance program bas$ 
^u pati5t safety measures & cl9ical     
quality measures %\ld be us$ 9 det]m9+ a
 value bas$ paym5t model = suppli]s &   
provid]s ( air ambulance s]vice2 &  7#i7
 any o!r in=mation deem$ relevant &     
appropriate by ! ,m$ic>e ,paym5t        
,advisory ,commission = ! purposes (    
provid+ su* recomm5dations4