The House Ways and Means Committee today unanimously approved a two-year extension of pandemic-era telehealth flexibilities, setting up what could be a prominent piece of a year-end health care package, Victoria reports.

Why it matters: While many providers and lawmakers have argued for a permanent extension, the cost makes that unrealistic. The CBO projected a previous temporary extension would have a price tag of more than $2 billion.

Driving the news: The package would extend a set of Medicare virtual care flexibilities that are due to expire at the end of this year through 2026. They include:

• Waiving geographic and originating site restrictions and a requirement that Medicare beneficiaries need to have an in-person visit before accessing virtual behavioral health care services.
• Extending flexibilities for rural health clinics and federally qualified health centers, and expanding how many practitioners are eligible to provide virtual care.
• The package also would extend the federal hospital-at-home program for five years (more on that below), along with extending programs for certain low-volume and Medicare-dependent hospitals.
• The bill would impose transparency and compensation requirements on PBMs to cover the cost of the extension, along with Medicare clinical laboratory testing changes.

Ways and Means was also on track to advance several rural health-related bills today.

• One measure would revise the fee schedule for ambulances so they would be paid the critical-access hospital rate for serving more outlying facilities.
• Other Republican-led bills would provide grants to rural hospitals for a stabilization pilot program, distribute graduate medical education residency positions to rural areas and make it easier for facilities to be given a rural emergency hospital designation.

What's next: Expect the House Energy and Commerce Committee to mark up telehealth legislation next.

The cost of the telehealth extension would be covered in part by projected savings from delinking and transparency requirements on PBMs, Victoria reports.

Why it matters: It's another sign of eagerness to crack down on PBMs, after some provisions almost made it into the March government funding deal.

Zoom in: This telehealth package has PBM language similar to the House's health cost transparency package.

• It also includes a "delinking" requirement that PBMs only receive income from service fees, and do not receive incentive payments unless they are flat fees.
• This is modeled on parts of the Protecting Patients Against PBM Abuses Act from Reps. Buddy Carter, Lisa Blunt Rochester, Nicole Malliotakis and Jake Auchincloss.
• The bill doesn't go so far as banning spread pricing for PBMs — a proposed change that has legs in the Senate.

The other side: The PBM trade group PCMA said the requirements shouldn't be used to offset the cost of the package and amount to a bailout for big drugmakers.

Reps. Brad Wenstrup and Earl Blumenauer are pressing for a five-year extension of a federal program that delivers hospital-level care in patients' homes.

Why it matters: The Acute Hospital Care at Home program is viewed as a model for treating frail Medicare patients that could ease overcrowding in inpatient settings and fill gaps in care in outlying areas.

• Language extending the program was included in the telehealth bill that House Ways and Means approved today.

What's inside: The Hospital Inpatient Services Modernization Act would extend waivers allowing certain Medicare-certified hospitals to treat patients with inpatient-level care at home.

• The waivers suspend requirements for 24/7 nursing services on the premises and for a registered nurse to be immediately available.
• Participating hospitals have to report data to CMS for ongoing monitoring of patient safety.

327 hospitals in 37 states are approved to participate in the program, which is operating under a temporary extension that expires at year's end.

• It's an outgrowth of the "Hospital Without Walls" initiative that CMS launched in the spring of 2020 to relieve health systems swamped by COVID-19 cases.

Sens. Tom Carper and Tim Scott have sponsored companion legislation in the Senate.

What we're watching: Whether the telehealth bill or another vehicle carries the bipartisan plan across the finish line.