The Appalachian Communities Health Equity Act of 2025 (ACHE Act of 2025) proposes a significant pause on certain federal authorizations for mountaintop removal coal mining. This moratorium applies to the issuance and renewal of permits for surface coal mining that uses explosives in the steep slope regions of Kentucky, Tennessee, West Virginia, and Virginia. The core purpose is to address serious health concerns raised by communities and scientific research regarding the impacts of this mining method. A central provision of the bill requires the National Institute of Environmental Health Sciences (NIEHS) to conduct a comprehensive study on the health impacts of mountaintop removal coal mining on nearby residents. Upon completion, the NIEHS Director must submit a public report, after which the Secretary of Health and Human Services (HHS) will publish a determination on whether health risks exist. The moratorium on federal authorizations will only be lifted if the HHS Secretary concludes that mountaintop removal coal mining presents no health risks. Furthermore, the bill mandates that all existing mountaintop removal coal mining projects implement continuous monitoring for water, air, and noise pollution, and consistent monitoring for soil pollution. Operators must submit these results monthly to the HHS Secretary, who will make them publicly available in a searchable database. Non-compliance with these monitoring requirements will result in the denial of federal authorizations for the project. To cover the federal costs of the health study and monitoring, a one-time fee will be assessed and collected from past and present mountaintop removal coal mining operators.