The PEAKS Act modifies Medicare rules for critical access hospitals, which are small rural hospitals that serve remote areas. The legislation protects hospitals that currently qualify as critical access hospitals based on mountainous terrain or secondary roads by allowing them to maintain that designation even if a new hospital opens within 10 to 15 miles of them, as long as they can demonstrate they originally met the distance requirement. The bill also expands ambulance service coverage for critical access hospitals in mountainous or remote areas by allowing Medicare to reimburse services up to 15 miles away instead of just 35 miles in certain cases, effective January 1, 2025. The Secretary of Health and Human Services must issue regulations within one year to implement the first provision. This legislation aims to preserve emergency access to healthcare in rural, hard-to-reach communities by preventing rural hospitals from losing their critical access status due to changes in nearby facilities.