A struggle over decades to force insurers to cover mental health and addiction services on the same basis as medical and surgical costs is headed for success under new rules issued on Friday by the Obama administration. The rules will cover most Americans with health insurance, including those in many employer-sponsored plans, in other group plans, in some but not all Medicaid plans, and in policies bought on the individual markets.
The rules strengthen a 2008 law that required parity in coverage — but only when an insurer actually offered mental health and addiction benefits. It did not require such benefits. The new health care law, the Affordable Care Act, does require coverage for mental health and substance abuse as 1 of 10 essential benefits in any new health plans. Combined, the two complete the job of offering both parity and coverage.
What the new rule would mean in practice is that limits on the amount of co-payments and the number of doctor visits or hospital days cannot be less generous than those that apply to most medical and surgical benefits. The same would be true of other rules, like those requiring prior authorization.
The New York Times