The ARCH Act extends special Medicare payment protections for rural hospitals that serve areas with limited healthcare options. Specifically, it extends enhanced payment rates for Medicare-dependent hospitals and low-volume hospitals through 2029, five years beyond their current expiration dates of 2024. These payment adjustments help rural hospitals that rely heavily on Medicare patients or treat fewer patients overall maintain financial stability. The bill also directs the Government Accountability Office to complete a study within 180 days that examines how Medicare classifies rural hospitals, identifies overlapping classifications, and recommends ways to simplify these categories and improve the long-term financial viability of rural healthcare facilities. No specific federal funding is appropriated in the bill, as it modifies existing Medicare payment formulas.