With help from Daniel Lippman, Caitlin Emma, Anthony Adragna, Ben Leonard, Alice Miranda Ollstein, David Lim, Lauren Gardner, Megan R. Wilson and Carmen Paun 

PROGRAMMING NOTE: We’ll be off next week for the holidays but will return to your inboxes on Tuesday, Jan. 3.

ALL THE TRIMMINGS — With federal cash set to expire Friday night, Congress is now fervently working to pass the year-end spending package that dropped early Tuesday morning. The massive deal was rammed with major health provisions that could make it to Biden’s desk this week.

“The omnibus is aggressive, generous and far-reaching in health care, making it more affordable, more extensive,” said Senate Majority Leader Chuck Schumer on Tuesday. “The sooner we pass the omnibus, the better. And I’m hopeful no senator will stand in the way of us finishing our work before Friday. It's too important to the American people.”

Here’s a breakdown of some key health policy provisions that made it in — and a few notable ones that didn’t.

An earlier end to Covid rules. he bill includes a bipartisan deal to end a Covid-era Medicaid policy that gave states additional funding and barred them from kicking people off federally funded insurance, setting a new end date of April 1, 2023.

Extension of telehealth. Tucked in the bill is an extension of HHS rules that made telehealth more accessible during the pandemic. But the provision, which extends the flexibility through the end of 2024, falls far short of the permanent flexibility that some lawmakers pushed for.

Major wins in the opioids fight. A long list of measures aimed at tackling the ongoing opioid crisis is in the bill, including $1,575,000,000 in state grants to go toward substance abuse prevention and treatment. It also incorporates significant provisions of the Mainstreaming Addiction Treatment Act, including the elimination of a DEA requirement that clinicians get an extra certification to prescribe buprenorphine, and the NOPAIN Act, which improves access to FDA-approved non-opioid therapies for outpatient surgical procedures.

Pandemic preparations. The bill calls on the Administration for Strategic Preparedness and Response to report to Congress on the feasibility of developing an AI-enabled pandemic preparedness and response program. ASPR would take the lead with help from the Defense and Energy departments as needed.

The bill also includes provisions from legislation championed by retiring Sen. Richard Burr (R-N.C.) and Senate HELP Chair Patty Murray (D-Wash.) to shore up U.S. preparedness for future pandemics. Additionally, the spending deal seeks to improve infectious-disease forecasting and modeling, establish an Office of Pandemic Preparedness and Response within the White House and institute more frequent reviews of the Strategic National Stockpile.

WELCOME TO WEDNESDAY PULSE — Does anything really cure a hangover? Despite the growing market for vitamin patches and products containing Korean pear juice, it appears… no. Got your own secret cure? Send it! And your news, of course, to [email protected] and [email protected].

TODAY ON OUR PULSE CHECK PODCAST, Megan Messerly talks with Alice Miranda Ollstein about the state abortion battles they followed in 2022 after the Supreme Court overturned the landmark Roe v. Wade decision — throwing the future of abortion access in the U.S. into flux — and what they’re looking at next year.

Our breakdown of the omnibus’ health highlights continues: 

Changes at the FDA. As part of the legislation, lawmakers overhauled the way cosmetics are regulated for the first time since the 1930s, giving the FDA greater authority to ensure that myriad lotions and makeup products are safe for use. It also includes changes to the FDA’s accelerated approval pathway for drugs, giving the agency clear authority to require post-approval clinical trials to confirm a product’s benefit.

A new home for ARPA-H. The new Advanced Research Projects Agency for Health will be part of the National Institutes of Health, settling a dispute over whether the agency should be independent, but the question of where its headquarters will be was left open.

Mental health investments. The package provides several key investments to expand access to mental health, including grants for maternal mental health, the Community Health Service Block Grants and the Substance Use and Prevention, Treatment and Recovery Block Grants.

A boost for global health spending. The deal carves out $11.2 billion for global health. The funds will go through the State Department, the Agency for International Development, HHS and the CDC. The biggest boost, $445 million, will go to HIV/AIDS programs, for a total of $6.7 billion.

Notably absent from the package: 

That pandemic aid … President Joe Biden had wanted $9 billion to help combat the Covid pandemic and address emerging needs, but Republicans had always been unwilling to provide extra cash.

A funding boost for family planning. The bill keeps funding flat for the Title X family planning program for the ninth year in a row, a blow to reproductive health groups that had argued the fall of Roe v. Wade warranted a substantial increase.

The VALID Act. Legislation that would have overhauled regulation of diagnostics and laboratory-developed tests fell out after House Energy and Commerce Committee ranking member Cathy McMorris Rodgers (R-Wash.) led efforts to block the provision.

Help for pregnant workers. Legislation that would have expanded protections for pregnant workers, called the Pregnant Workers Fairness Act, was left out of the bill after being stalled in the Senate for months despite support from groups like the U.S. Chamber of Commerce, the ACLU and the United States Conference of Catholic Bishops.

THE WINTER VIRUS SPIKE IN NYC — New York City is seeing a holiday spike in Covid-19 cases, along with flu and respiratory syncytial virus, POLITICO’s Erin Durkin reports.

Mayor Eric Adams called the situation on Tuesday “extremely challenging.”

Covid cases have jumped to 3,636 a day on average, an increase of about 50 percent since Thanksgiving. At the same time, the city recorded 16,890 flu cases in the most recent week of data, already higher than the peak of the last four winter flu seasons. RSV cases have begun to decline since peaking in the fall but are still at high levels.

FLORIDA GOING GREEN — The Florida Department of Health took a step toward issuing more licenses for businesses to sell and grow medical marijuana with more emergency rules, POLITICO’s Arek Sarkissian reports.

On Tuesday, the Florida Office of Medical Marijuana Use posted new emergency rules that define the structure of the process to handle applications to issue more licenses. The state anticipates more than 40 available licenses by the end of June. The new rules direct the office to issue those licenses in batches versus making dozens of them available.

Subhan Cheema is the new communications director for the Office of Science and Technology Policy. Cheema previously worked on the White House Covid-19 response team, where he was deputy director for strategic communications and external engagement.

New Jersey’s RWJBarnabas Health has appointed Frank Pipas as executive vice president and chief financial officer and Balpreet Grewal-Virk as senior vice president of community health.

The American Medical Association has added Suzanne Joy and Jeff Coughlin as assistant directors of federal affairs. Joy previously was senior adviser for public policy and regulation at Holland & Knight. Coughlin previously was senior director of federal and state affairs at the Healthcare Information and Management Systems Society.

The Wall Street Journal investigates a decades-old federal program that gives drug discounts to hospitals that aren’t passed on to patients.

The DEA seized enough fentanyl this year to kill everyone in the U.S., The Washington Post reports.

Stat reports on how racism negatively impacts sleep and its many benefits.