Partial Nonenforcement of Mental Health Parity and Addiction Equity Act Rules

On May 15, 2025, the Departments of Labor, Health and Human Services, and Treasury (the Departments) announced a nonenforcement policy for portions of the final mental health parity rules. Specifically, they will not enforce the new requirements imposed by the Mental Health Parity and Addiction Equity Act (MHPAEA) 2024 Final Rule. This action temporarily pauses the new compliance requirements that employers generally consider to be quite onerous, so this may be seen as welcome relief. 

That said, health plans must still comply with the final 2013 MHPAEA regulations and must complete a Comparative Analysis of the nonquantitative treatment limitations (NQTLs) in their plan as required by the Consolidated Appropriations Act.

Why did this happen?

The ERISA Industry Committee (ERIC) is an industry advocacy group comprised of very large, self-funded plans. They sued the Departments, alleging the 2024 Rule illegally expands the Departments’ statutory authority and violates procedural requirements. ERIC asked the court to invalidate the entire 2024 Final Rule, or alternatively, invalidate those provisions identified as particularly egregious (outlined below).

As a result of this lawsuit, the Departments issued a pause on enforcement until the final court ruling is made, plus an additional 18 months. This will allow the Departments (now led by appointees of the Trump administration rather than the Biden administration) to consider the regulations in light of the future result of the lawsuit. Armed with a clear court ruling on the 2024 Final Rule, they may retain, amend, or rescind the regulations.

A History Lesson

The following is a high-level overview of the history of the MHPAEA, from passage to the recent enforcement pause. 

1996 Mental Health Parity Act
This law first introduced the concept of parity between mental health and other medical benefits for large group health plans. However, the law faced criticism for vague definitions that made compliance difficult and had flaws that impeded effective implementation. The law also allowed health plans to be partially exempt if they demonstrated a cost increase of at least 2%. This combination of factors resulted in the law not making a significant impact on mental health parity. 

2008 MHPAEA Law
In an effort to further the cause and correct the flaws in the Mental Health Parity Act of 1996, the MHPAEA law was passed in 2008. It added definitional specificity and required that plan provisions for mental health/substance use disorder (MH/SUD) can be no more restrictive than for medical/surgical (M/S) benefits. This applies to the following categories of benefits:

• Quantitative Treatment Limits (QTLs) - Must provide equivalent coverage for MH/SUD as for M/S. Examples of QTLs include copays, deductibles, coinsurance, out-of-pocket maximums (OOPM), and visit limits (days and frequency).
• Non-Quantitative Treatment Limits (NQTLs) - Must also be equivalent. Examples of NQTLs include prior authorizations, step therapy, admission standards, and reimbursement standards.

2013 Final Rule
This regulatory guidance introduced six classifications of benefits for comparison:

• Inpatient in-network
• Inpatient out-of-network
• Outpatient in-network
• Outpatient out-of-network
• Emergency care
• Prescription drugs

This statute articulated that plans cannot “impose a greater burden on access” for MH/SUD than M/S when under the same benefit classification. These guidelines were for financial requirements relative to both QTLs and NQTLs. As such, this was not a heavy lift for health plans since the requirements were easily identified and measured. 

2021 CAA 
The Consolidated Appropriations Act took an additional step and required health plans to document a “Comparative Analysis” of the NQTLs. The requirement was to complete the analysis and to maintain documentation in case of an audit. When the regulatory agencies began to audit plans and review the Comparative Analysis documents, they were underwhelmed. They found what we all knew . . . as a rule, the comparative analysis documentation was a lot of words that effectively said little and did not truly present a valid comparison of MH/SUD benefits and access compared to M/S benefits and access. 

2024 Final Rule
The 2024 Final Rule added additional specificity and compliance elements to the NQTL comparative analysis requirements. Specifically, the following obligations were added as of 2025: 

• Fiduciary Attestation Requirement: Requires plan fiduciaries to certify that they have engaged in a prudent process in preparing and evaluating their plan’s comparative analyses of its NQTLs.
• Meaningful Benefits Rule: Requires plans to provide “meaningful” coverage for each mental health and substance use disorder (MH/SUD) condition in each classification that group health plan provides medical/surgical (M/S) benefits. “Meaningful” is defined as including one core or primary treatment for the condition.
• Outcomes Data Rule: Requires plans to collect and evaluate data that may indicate disparate participant access or use between M/S benefits and MH/SUD benefits, and take reasonable action steps to address any deficiencies.

2025 Enforcement Pause
The Departments announced they will not enforce the 2024 Final Rule for any compliance failure prior to a final decision in the pending lawsuit. This non-enforcement policy means that the new provisions of the 2024 rules will not be enforced: 

• Fiduciary Attestation Requirement
• Meaningful Benefits Rule
• Outcomes Data Rule

What to do now? 

While the enforcement pause may be a welcome relief, the Departments have made it clear that they remain committed to ensuring that plans are compliant with the non-paused compliance obligations of the MHPAEA law. They specifically clarified that regulatory guidance under the 2013 rules is still in force.

Plan fiduciaries should continue to engage in compliance as follows:

• Analyze NQTLs: Complete the analysis process to ensure that the “processes, strategies, evidentiary standards, and/or other factors the plan” for NQTLs are applied no more stringently to MH/SUD benefits than to M/S benefits in the same classification.
• Complete Comparative Analysis: Maintain written Comparative Analyses, keep them updated, and have them available to provide to regulators and participants upon request.
• Monitor Participant Complaints: Mental health parity is a focus for regulators and has traditionally seen bipartisan support. Employers should be aware that if a mental health care complaint surfaces, care should be taken to ensure that parity rules have not been violated. 

Looking Ahead

The team at Vita will keep you posted on developments in the lawsuit and employer compliance responsibilities.

Resources

2013 Final Rule

FAQs about Mental Health Parity