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Buried in the spending deal that congressional negotiators announced on Tuesday are several nuggets that should be of interest to hospitals, home health providers and pharmaceutical companies. They won't have any immediate impact but could lay the groundwork for significant policy changes. Congress is seeking answers from the CMS about its requirement that home healthcare agencies provide face-to-face certifications by a physician before the agency will cover in-home care for Medicare and Medicaid beneficiaries. The spending deal asks the agency to detail in its 2016 budget request how that requirement has prevented fraud, increased access to healthcare and affected costs for the Medicare and Medicaid programs. It also calls on the agency to present a plan for how the face-to-face certification requirement can be simplified. (Demko, 12/10)

A provision tacked onto the $1.1 trillion fiscal 2015 spending package would allow Blue Cross and Blue Shield health plans, which cover 100 million people, to count so-called health quality spending toward government requirements on insurance profits while maintaining favorable tax treatment. The medical loss ratio requirement under the 2010 health care law generally obligates large group health plans to pay out refunds if they don't spend at least 85 percent of their premiums on medical claims or so-called health-quality improvement plans. (O'Donnell, 12/10)

The $1.1 trillion spending bill pending on Capitol Hill includes two bipartisan changes to Obamacare, both technical corrections that so far have drawn little attention. The changes, involving expatriate health insurance plans and the tax status of nonprofit health insurance plans, represent relatively minor adjustments to the massive Affordable Care Act. But the fact that it is has taken this long to get them to the finish line shows how difficult it is to make even bipartisan changes amid the political turmoil that still surrounds the law. (Haberkorn, 12/10)

Republicans didn’t manage to get the big conscience protections on abortion and contraception they wanted into Congress’ bipartisan spending agreement — but they did get a few small wins. The bill contains language directing HHS to clarify within 30 days how insurance plans in ACA exchanges should disclose whether they cover elective abortions. Both abortion rights supporters and opponents acknowledge — and research has shown — that it’s hard for shoppers to find that information the way plan benefits are currently displayed. (Winfield Cunningham, 12/10)