Omnibus movement could mean bigger health care package

• Schumer added the Senate should be prepared to vote on a one-week CR later this week (as we have been anticipating) "so we can give appropriators more time to finish a full funding bill before the holidays."

Yes, but: There’s still no deal on appropriations top-line numbers. But Democrats did hold off on the release of their own omnibus proposal on Monday because of progress in bipartisan talks over the weekend.

• Sen. Richard Shelby said he spoke to Speaker Nancy Pelosi on Sunday and Monday, and the sides are "trading suggestions on how to bridge the gap" that he put around $25 billion.

Here's where the potential health care riders stand:

1) Diagnostic tests. There has been some movement on the VALID Act, which is aimed at modernizing a patchwork of regulations on diagnostic tests.

• Negotiators last week floated changes aimed at exempting some tests at academic medical centers, which had raised objections about what they view as cumbersome new regulations.
• But lobbyists say that the academic medical centers are still not won over and do not view the floated exemption as going far enough. That continues to be a hurdle for the bill.
• Still, the bill is in the mix, and we previously reported it could be part of a deal to be paired with stepping up FDA oversight of cosmetics.

2) Provider cuts. Doctors and other clinicians are still pushing for Congress to stop the entire Medicare payment cut in the physician fee schedule, and the American Medical Association and American Hospital Association ramped up lobbying with in-person Hill meetings last week.

• “I felt pretty good about my visits,” AMA president Jack Resneck told Maya on Monday. “I think even though there's a long list of things to do, [lawmakers] get the critical nature of this, and that this can't wait to be fixed next year.” Resneck said he’s continuing advocacy conversations this week.

3) Medicare Advantage. We’re still waiting on an updated CBO score for the Improving Seniors’ Timely Access to Care Act, which would streamline Medicare Advantage prior authorization.

• A new CMS proposed rule should slash the bill’s price tag, but it’s not clear yet if CBO will make that official. Advocates are pushing for the congressional budget wonks to weigh in, based on Axios' conversations with aides and lobbyists.

4) Puerto Rico. Members of the Puerto Rican government and health care industry met with House and Senate leadership last week to discuss Puerto Rico’s Medicaid funding cliff, a congressional aide and a Puerto Rico federal affairs staffer confirmed.

• While full details are still to be determined once there’s a top-line number, Carmen Feliciano, executive director of the Puerto Rico Federal Affairs Administration, said in a statement the FMAP level is likely to stay at the current 76% level based on discussions with Congress.
• “We believe that there is another CR beyond this Friday, the FMAP will be extended at the current 76%, and that the FMAP in any omnibus agreement will be at no less than 76% as well.”

5) Telehealth. If telehealth ends up being in the omnibus, it is likely to be only a one-year extension of the PHE flexibilities that end on Dec. 31, said Krista Drobac, a partner at Sirona Strategies.

• That’s because the CBO score would be favorable for one year and then could give more time for data and evidence to inform whether it should be extended further.
• In addition to pushing for continued Medicare telehealth flexibility, providers and some lawmakers are looking to extend a waiver that lets people with high-deductible health plans get telehealth coverage before their minimum deductible is met.
• The pandemic-era policy expires Dec. 31, but a group of 30 House lawmakers sent a letter to leadership Monday asking them to extend the waiver for another year.