The Centers for Medicare & Medicaid Services recently made several proposals that could reduce access to care in the community, particularly for vulnerable patients. The agency, in its proposed rule for the 2019 outpatient prospective payment system, proposed reducing payment for visits in certain off-campus hospital-connected clinics to 40 percent of the OPPS rate, a drastic cut. CMS also resurrected a proposal that would penalize these clinics if they have expanded the services they offer to their communities – taking away their ability to meet the changing needs of their patients and communities.