This bill, known as the Preserving Emergency Access in Key Sites Act (PEAKS Act), aims to update the fee schedule for ambulance services provided under the Social Security Act. It specifically amends the distance requirement for these services, allowing a 15-mile drive to be recognized in areas characterized by mountainous terrain or the presence of only secondary roads, as an alternative to the standard 35-mile drive. This adjustment is intended to better reflect the operational realities and challenges faced by ambulance providers in such difficult geographic locations. Additionally, the legislation addresses the designation criteria for Critical Access Hospitals (CAHs). It establishes that certain existing CAHs, which were originally designated based on meeting a 15-mile distance requirement due to mountainous terrain or secondary roads, will be deemed to continue meeting this criterion. This provision applies even if a new hospital or facility is subsequently located between 10 and 15 miles from the CAH, thereby helping these vital rural hospitals maintain their designation and continue providing essential emergency access.