1. Short title This Act may be cited as the Preserving Emergency Access in Key Sites Act or the PEAKS Act . 2. Update to fee schedule for ambulance services provided by critical access hospitals Section 1834(l)(8) of the Social Security Act ( 42 U.S.C. 1395m(l)(8) ) is amended in the flush left text following subparagraph (B) by inserting (or, in the case of mountainous terrain or in areas with only secondary roads available, a 15-mile drive) after 35-mile drive . 3. Treatment of hospitals that met mountainous terrain or secondary roads distance requirement for designation as critical access hospital Section 1820(h) of the Social Security Act ( 42 U.S.C. 1395i–4(h) ) is amended by adding at the end the following new paragraph: (4) Treatment of hospitals that met mountainous terrain or secondary roads distance requirements for designation (A) In general Beginning January 1, 2025, in the case of a hospital described in subparagraph (B), such hospital shall be deemed to meet the 15-mile distance requirement for mountainous terrain or secondary roads described in subsection (c)(2)(B)(i)(I). (B) Hospital described A hospital described in this subparagraph is a hospital that— (i) as of the date of enactment of this paragraph, is designated as a critical access hospital; (ii) demonstrates (in a manner determined by the Secretary) that the hospital met the 15-mile distance requirement for mountainous terrain or secondary roads described in subsection (c)(2)(B)(i)(I) as of the hospital’s last certification as a critical access hospital; and (iii) after such date of enactment, has a new hospital or other facility described in this subsection that is located not less than 10, but no more than 15, miles from the hospital. (C) Regulations Not later than 1 year after the date of enactment of this paragraph, the Secretary shall promulgate regulations to carry out this paragraph. .