Congressional Republicans made Democrats an offer on a major package of year-end health provisions this week, sources say.

Why it matters: The large-scale offer shows that momentum remains behind finishing a major health package this year, though a deal is far from certain.

• Democrats are reviewing the offer. There are typically multiple back-and-forth exchanges in these kinds of negotiations.

What’s inside: The offer includes additional health policies beyond what are regarded as “must do” extenders like community health center funding and telehealth flexibilities.

• The offer includes “delinking” of PBM compensation from the price of a drug in Medicare Part D.
• On the hospital front, it does not include site-neutral payments for physician-administered drugs, but it does include a related policy to require providers to use a unique identifier number to crack down on what critics call “dishonest billing.”
• Democrats are also objecting to a GOP proposal to use repeal of the Biden administration nursing home staffing rule as a major payfor.

The big picture: Despite the offer, there is a long way to go. Some sources still expected that negotiators will run out of time and have to fall back on a three-month bare-bones extension of expiring programs.

• The proposal is widely circulating among lobbyists, which also can pose an obstacle for serious negotiations in Congress.
• The broader funding picture also matters, and it’s unclear if leadership wants to complicate government funding with extra health matters.