II 

118TH CONGRESS 

2D SESSION S. 4101 

To amend title XVIII of the Social Security Act to provide for the continued 

designation of hospitals that met mountainous terrain or secondary roads 

distance requirement as critical access hospitals and to modify distance 

requirements for ambulance services furnished by critical access hospitals. 

IN THE SENATE OF THE UNITED STATES 

APRIL 10, 2024 

Mr. MANCHIN (for himself, Mrs. CAPITO, Mr. TESTER, and Mr. BARRASSO) 

introduced the following bill; which was read twice and referred to the 

Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for the continued designation of hospitals that met 

mountainous terrain or secondary roads distance requirement as critical access hospitals and to modify distance 

requirements for ambulance services furnished by critical 

access hospitals. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Preserving Emergency 

5 Access in Key Sites Act’’ or the ‘‘PEAKS Act’’. 


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•S 4101 IS

1 SEC. 2. TREATMENT OF HOSPITALS THAT MET MOUN2 TAINOUS TERRAIN OR SECONDARY ROADS 

3 DISTANCE REQUIREMENT FOR DESIGNATION 

4 AS CRITICAL ACCESS HOSPITAL. 

5 Section 1820(h) of the Social Security Act (42 U.S.C. 

6 1395i–4(h)) is amended by adding at the end the following 

7 new paragraph: 

8 ‘‘(4) TREATMENT OF HOSPITALS THAT MET

9 MOUNTAINOUS TERRAIN OR SECONDARY ROADS DIS10 TANCE REQUIREMENT FOR DESIGNATION.— 

11 ‘‘(A) IN GENERAL.—In the case of a hos12 pital described in subparagraph (B), the hos13 pital shall be deemed to meet the 15-mile dis14 tance requirement for mountainous terrain or 

15 secondary roads described in subsection 

16 (c)(2)(B)(i)(I) on or after January 1, 2026. 

17 ‘‘(B) HOSPITAL DESCRIBED.—A hospital 

18 described in this subparagraph is a hospital 

19 that— 

20 ‘‘(i) as of the date of enactment of 

21 this paragraph, is designated as a critical 

22 access hospital; 

23 ‘‘(ii) demonstrates (in a manner deter24 mined by the Secretary) that the hospital 

25 met the 15-mile distance requirement for 

26 mountainous terrain or secondary roads 


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•S 4101 IS

1 described in subsection (c)(2)(B)(i)(I) as of 

2 the hospital’s last certification as a critical 

3 access hospital; and 

4 ‘‘(iii) after such date of enactment, 

5 has a new hospital or other facility de6 scribed in this subsection located within 

7 10–15 miles of the hospital. 

8 ‘‘(C) REGULATIONS.—Not later than 1 

9 year after the date of enactment of this para10 graph, the Secretary shall promulgate regula11 tions to carry out this paragraph.’’. 

12 SEC. 3. MODIFICATION OF DISTANCE REQUIREMENTS FOR 

13 AMBULANCE SERVICES FURNISHED BY CRIT14 ICAL ACCESS HOSPITALS. 

15 Section 1834(l)(8) of the Social Security Act (42 

16 U.S.C. 1395m(l)(8)) is amended, in the flush matter fol17 lowing subparagraph (B), by inserting ‘‘(or, for such serv18 ices furnished on or after January 1, 2025, in the case 

19 of mountainous terrain or in areas with only secondary 

20 roads available, a 15-mile drive)’’ after ‘‘35-mile drive’’. 

Æ 


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