Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023

This bill amends the Social Security Act to expand the mental health care workforce and services under Medicare and Medicaid, reduce prescription drug costs, and extend certain expiring Medicare and Medicaid provisions.

TITLE I, Expanding mental health care workforce and services under Medicare and Medicaid: This title expands eligibility for Medicare bonus payments to mental health and substance use disorder practitioners in shortage areas, improves access to mental health services (including clinical social worker services in skilled nursing facilities), clarifies occupational therapy coverage for mental health, creates Medicare incentives for behavioral health integration with primary care for 2026-2028, establishes a telehealth modifier for mental health services, and requires guidance on telehealth for limited English proficiency patients, interstate licensure, and accessibility for the visually and hearing impaired. It also requires accurate Medicare provider directories, and directs HHS to issue guidance to states on increasing mental health provider capacity, supporting children's mental health, integrating care with primary care, and analyzing Medicaid mental health data. It creates a state option to provide Medicaid to certain inmates with substance use disorder pending charges, and defines certified community behavioral health clinic services under Medicaid.

TITLE II, Reducing prescription drug costs under Medicare and Medicaid: This title requires Medicare Part D plans to accept any willing pharmacy meeting standard contract terms starting in 2028, mandates HHS surveys to determine accurate pharmacy acquisition costs for Medicaid, and ties Medicare Part D cost-sharing for certain drugs to their net price starting in 2028.

TITLE III, Medicaid expiring provisions: This title delays certain Medicaid disproportionate share hospital payment reductions to fiscal years 2026 and 2027, and makes permanent the state option to provide medical assistance for certain individuals in institutions for mental diseases.

TITLE IV, Medicare expiring provisions and provider payment changes: This title extends funding for quality measure endorsement, low-income program outreach, the work geographic index floor, and incentive payments for alternative payment models. It delays certain durable medical equipment payment changes, extends the Independence at Home demonstration program, increases support for physicians adjusting to payment changes, revises the phase-in of clinical laboratory test payment changes, and extends the adjustment to the hospice cap calculation.

TITLE V, Offsets: This title reduces the amount in the Medicaid Improvement Fund and increases the amount in the Medicare Improvement Fund.