Mental Health Parity and Addiction Equity Act 2024 Final Rule Non-enforcement Policy

June 2025

Deanna Sizemore, Associate Director, Benefits Compliance
Dan Finnegan, Compliance Specialist, Benefits Compliance

The Mental Health Parity and Addiction Equity Act (“MHPAEA”), requires group health plans and insurers who offer mental health and substance use disorder (“MH/SUD”) benefits to be offered in parity with medical/surgical benefits (M/S). The Consolidated Appropriations Act of 2021 (“CAA 2021”), expanded these requirements to include the obligation to prepare a detailed written comparative analysis of nonquantitative treatment limitations (“NQTLs”). In 2024, federal agencies issued final rules to strengthen enforcement of these provisions.

However, in January 2025, the ERISA Industry Committee (“ERIC”) filed a lawsuit against the U.S. Departments of Health and Human Services, Labor, and the Treasury (the “Departments”), challenging the legality of the new rules. In response, the Departments announced they will delay enforcement of the 2024 rules until a final court decision is issued, followed by an additional 18-month period. This enforcement relief applies only to specific provisions of the 2024 Final Rule.

Employer Action Items

• Adhere to MHPAEA Compliance Requirements. Employer plan sponsors should continue to comply with the legislative and regulatory requirements of MHPAEA (as amended by the CAA 2021).
  • Fully Insured plans should confirm that insurance issuers and other carriers have completed and documented a written comparative analysis of NQTLs, and the plan sponsor should obtain a written certification of compliance from the vendor.
  • Level and Self-Funded plans are responsible for the development of the written comparative analysis of NQTLs imposed by their plan(s), as well as respecting compliance with additional substantive requirements of the law (e.g., quantitative treatment limitation analysis, participant disclosure obligations, removal of lifetime and annual limits from MH/SUD benefits, and more). These employers should coordinate their compliance efforts with their insurance issuers and administrators, and they may need to engage a third-party professional services firm for the production of their plan’s written comparative analysis of NQTLs.
• Maintain Transparency and Perform Participant Disclosure Obligations. Upon request, plans must provide the NQTL comparative analysis to federal and state regulators, as well as for the benefit of plan participants who have MH/SUD claims or appeals denied, or who specifically request a copy of the written comparative analysis (in writing).
• Stay Informed and Maintain Ongoing Compliance Assuredness Activities. Employers should continue to monitor the status of ongoing litigation and should keep an eye out for the publication of future regulatory guidance from the Departments relative to MHPAEA.

Summary

As a result of pending litigation brought forward by ERIC, and respecting the tenets of Executive Order 14219 (“Ensuring Lawful Governance and Implementing the President’s ‘Department of Government Efficiency’ Deregulatory Initiative” – directing federal agencies to reivew regulations and identify those that may undermine the national interest, including the imposition of undue burdens upon small businesses, or significant costs upon private parties, which are not outweighed by their public benefit), the Departments have issued a statement informing plan sponsors and employers that the Departments will not enforce the 2024 Final Rule, or otherwise pursue enforcement actions, based on a failure to comply that occurs prior to a final decision in the litigation (plus an additional 18 months). The Departments also advised they will “undertake a broader reexamination of each department’s respective enforcement approach under MHPAEA, including those provisions amended by the CAA 2021”.

While the Departments will not be enforcing the substantive requirements of the 2024 Final Rule until there is a final decision in the litigation (plus 18-months), the Departments requested that the ERIC litigation be held in abeyance (that is, temporarily suspended), while the Departments reconsider the 2024 Final Rule.

The enforcement relief applies only with respect to those portions of the 2024 Final Rule that are new in relation to the prior existing 2013 Final Rule. It is important to note that the 2013 Final Rule (as amended by the CAA 2021) remains in full force and effect, and enforcement actions for violations related to the 2013 regulations have not been suspended. Plan sponsors and insurance issuers must continue to comply with MHPAEA, just as they were required to do prior to the publication of the 2024 Final Rule.  

The elements of the 2024 Final Rule that are being contested are the following:

• Meaningful Benefits: This provision states that if benefits are provided in a M/S classification, the plan must offer MH/SUD benefits in every classification in which meaningful M/S benefits are provided. Meaningful benefits are those required for coverage of core treatments for conditions and disorders relative to each classification within which the plan offers the same benefit for one or more medical conditions or surgical procedures. ERIC is alleging that the Departments have exceeded their statutory authority in issuing these provisions by creating a benefit mandate for plan sponsors.
• Evaluation of Relevant Outcomes Data: Consistent with the provisions of the 2024 Final Rule, employee benefits plan sponsors and insurance issuers must collect and evaluate relevant outcomes data, taking reasonable action to address material differences in access existing between MH/SUD benefits and M/S benefits. ERIC alleges this requirement goes beyond the statutory requirements of MHPAEA (which merely requires parity in respecting the terms of the plan, and the application of such terms, rather than the outcomes they actually produce).
• Fiduciary Certification Requirement: For plans subject to ERISA, the 2024 Final Rule provided that the required written comparative analysis of NQTLs must include must include a written certification by one or more named fiduciaries who have reviewed the analysis, advising whether, and to what extent, the comparative analysis is compliant with the content requirements of the 2024 rule.  ERIC alleges that this requirement exceeds the DOL’s statutory authority and is arbitrarily and capriciously burdensome to ERISA fiduciaries, as well as violates due process expectations.

Additional Information & Resources

• Statement of U.S. Departments of Labor, Health and Human Services, and the Treasury regarding enforcement of the final rule on requirements related to the Mental Health Parity and Addiction Equity Act.
• The ERISA Industry Committee v. United States Department of Health and Human Services.
• Requirements Related to the Mental Health Parity and Addiction Equity Act