The Trump Administration is pursuing a new policy that could jeopardize the status of dozens, if not hundreds, of Critical Access Hospital across the United States. The issue involves the location of designated Hospital Outpatient Departments within 35 miles of a CAH. CMS now says that an HOPD is an extension of a hospital and, therefore, a CAH within 35 miles of an HOPD is in violation of the rules. How this impacts existing CAHs that had been designated as Necessary Providers (prior to January 1, 2006) is unclear. In 2013, the Office of Inspector General audited all the critical access requirements and found a number of critical access hospitals didn’t comply.