,,ii  #aahth ,,congress  #b;d ,session  
,s4 #daja  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,april #aj1    
#bjbd,mr4 ,manchin 7for himself1 ,mrs4  
,capito1 ,mr4 ,tester1 and ,mr4         
,barrasso7 introduced the following     
bill2 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 hospitals4 
#a4 ,short title ,this ,act may be cited
 as the ,preserving ,emergency ,access  
in ,key ,sites ,act or the ,,peaks ,act4
  #b4 ,treatment of hospitals that met  
mountainous terrain or secondary roads  
distance requirement for designation as 
critical access hospital ,section       
#ahbj7;h7 of the ,social ,security ,act 
7#db ,u4,s4,c4 #acie;i-#d7;h77 is       

amended by adding at the end the        
following new paragraph3  7#d7          
,treatment of hospitals that met        
mountainous terrain or secondary roads  
distance requirement for designation    
7,a7 ,in general ,in the case of a      
hospital described in subparagraph 7,b71
 the hospital shall be deemed to meet   
the #ae-mile distance requirement for   
mountainous terrain or secondary roads  
described in subsection                 
7c77#b77;,b77i77,i7 on or after ,january
 #a1 #bjbf4  7,b7 ,hospital described ,a
 hospital described in this subparagraph
 is a hospital that-- 7i7 as of the date
 of enactment of this paragraph1 is     
designated as a critical access         
hospital2  7ii7 demonstrates 7in a      
manner determined by the ,secretary7    
that the hospital met the #ae-mile      
distance requirement for mountainous    
terrain or secondary roads described in 
subsection 7c77#b77;,b77i77,i7 as of the
 hospital's last certification as a     
critical access hospital2 and  7iii7    

after such date of enactment1 has a new 
hospital or other facility described in 
this subsection located within #aj-ae   
miles of the hospital4  7,c7            
,regulations ,not later than #a year    
after the date of enactment of this     
paragraph1 the ,secretary shall         
promulgate regulations to carry out this
 paragraph4  4  #c4 ,modification of    
distance requirements for ambulance     
services furnished by critical access   
hospitals ,section #ahcd7l77#h7 of the  
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7l77#h77 is amended1 in the flush 
matter following subparagraph 7,b71 by  
inserting 7or1 for such services        
furnished on or after ,january #a1      
#bjbe1 in the case of mountainous       
terrain or in areas with only secondary 
roads available1 a #ae-mile drive7 after
 #ce-mile drive4